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FOR OFFICE .USE: <br /> �-� 7 /. ft -------------- ` C <br /> ry <br /> -__-_____-____-__-_______________ APPLICATION FOR SANITATION PERMIT Permit No. ..��.� <br /> ------- ---------------------------------------------- (Complete in Duplicate) <br /> ----------------------- This Permit Expires 1 Year From Date Issued Date Issued ............ <br /> Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION............... ---------//--- p�-- ----..�«�pCl.�..-- ------'-----... . - ---------'-- ----. ...... <br /> Owner's Name...._-..----z+�xy....... 4�'� - Pho T_ 7 <br /> Address-•--•{�` ---------------------------------•--- - -•- -•�-�--� _..---•-------------.. <br /> C lam.._.. Ph <br /> Contractor's`Name_---=__ --- r_ _------ ..._�iL -..— <br /> �7tL <br /> Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ,. Number of living units: --- Number of bedrooms _Number of baths J. Lot size %1..l0 ................' <br /> Water Supply: Public system 7�_Community system ❑ Private ❑ Depth to Water Tabl <br /> Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe + Hardpan ❑ <br /> Previous Application Made: {If yes,date--------------------1 No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> o septic tank or cesspool permitted if public sewer is available within 200 feet.} <br /> F ti T4W.r Distance from nearest well-----------------Distance from foundation--------------------Material................................................. <br /> ,... <br /> No. of compartments---------_--------------Size------------------f` Liquid depth--------------------------Capacity-••-----•--•- <br /> - x <br /> I 1�J Distance from nearest well- D------Distance from foundation__ ___ <br /> f .---Distance to nearest lot inp.---. .... <br /> Number of linesAM ----- --- ---- ----- - ---Length of each line-- -_�-_-_-Width of trench---- <br /> 1 /� �j <br /> -A94 TypeType of filter materiae-LGL_-Depth of filter material___1f.T--_-- ..-Total length_.-... .6___e.............:.. [ <br /> ���9I Distance to nearest well__10Q--. __--Distance from' foundation_..Z.0---____.Distance to nearest lot line. <br /> } --------------- Size: Diameter--- ----- <br /> q Number of pits---l� _-Lining material--RV _- ���-�'`----Depth----��r.._---_ <br /> Cesspool: Distance from nearest well from oundation-------_---------.Lining material..................................... <br /> ❑ p t L Liquid Capacity gals. <br /> Size: Diameter--------------------------------------De Depth �_ ------------------------------•- -- <br /> Privy: Distance from nearest well--------------------------------'-------.-------Distance from nearest building---_----__-_-------_----__-_---_----t- ' <br /> ❑ Distance to nearest lot line-----------------------a---------------------------------------------------------------•-•---•------. ------•---•--•---•-----•-•-------- <br /> Remodeling and/or repairing Idescribe�i---- ----­-------------------- <br /> ---------- <br /> ---.___••--------------- <br /> r =.. <br /> -- <br /> --------------------- <br /> --------------0- <br /> ------------------------------ <br /> /_ - <br /> �__/h--------------------------- <br /> -- -- - x- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance Stat s, a ules:and re ulations of the San Joa uin Local Health District. <br /> r <br /> [Signed} 'L'�"' _ -.1 #-- ••----_-_---•----- Contractor) <br /> a 1.. { itie <br /> BY=-•-----------;--•-•--•---••-----------••-----------•--•-- ------------------------------- --------- - -------- J •--•-------•-----------.--------.------.---------------- <br /> (Plot plan, showing size of lot, location of stem in relation o ells, buildings, ., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- -- - ---------------------------------------------------- DATE--------- -r '..- /---------- <br /> REVIEWEDBY--------------------------------- -------------------------------------------------------•----------•--------•-••--------•--- DATE.---- •-------------------•------------------------------- <br /> BUILDINGPERMIT ISSUED-------- ---------------------------------------------------–................'---------------------- DATE------------------------------------------------------------- <br /> 0 and/or recommendations:-----_--_-------_---- j <br /> ........I--------------------------------------------------------------------------------------------------------••------•_----•-•-----------•--•---------------•------------•----------------------------••--•---•----- <br /> , 1 , <br /> ------------ ---------I.,----------- ----- ................... --------------------------------------------------------------------------------------------------- <br /> ---------••--•--•------------- <br /> FINAL INSPECTION BY:------- -- ----•-----'----`--`---'-------------------- Date------------ / _A---- ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 west 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E6 9 REVISEO 6.59 PM 5-61 ATLAS <br />