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j/ FOR OFFI(;E U�Euhf f'` : <br /> ------------- APPLICATION FOR SANITATION PERMIT Permit No- ------r .... ... ... <br /> .. <br /> --------------------------------------------------------- <br /> (Complete in Duplicate) <br /> Date Issued <br /> -- -------- <br /> This Permit Expires I Year From Date Issued <br /> --------------- --- <br /> Application is hereby made to the San Joaquin Local Health District for 6 permit to construct and install the work herein de;crUd. <br /> This application is made in compliance with County Ordinance No. 549. <br /> "*-3 �I 't 6, 5 T_" . 7 4�- (-7 <br /> ---­----­----- ............... <br /> - ---------- -A- ------ --------------------- ................. <br /> JOB ADDRESS AND LOCATION_ <br /> Phone......................------------- <br /> ---------- -------- <br /> Owner's Name-------------0._t�..... ----- ------------- <br /> Address-_.....................................Z A ------------•---------------------------------------------- --- r <br /> ----------------- <br /> - ----------- Phone-•-•--•-•- <br /> ........... <br /> . ....- - ----------4_�-- ----- --------- <br /> Contractor's Name_ <br /> Installation will serve- Residence EKAparfment House 171 Commercial ,E]'7railer Court E] Motel 0 Other [I <br /> Number of living units: -j.---" 'Number of bedro"o ns13-;- Number of baths Lot,size --------------•--=•- <br /> .. . <br /> Water <br /> ------------- <br /> Water Supply: Public system Ey"'CEommunity system 0 Private F <br /> I I Depth To Water j Table 5- ._ ft. Adobe 8---qa_rdpan 0-7 <br /> Character of soil to a depth of 3 feet: Sand (3 Gra�el C] Sandy Loam El Clay Loa4iE] Clay [] Ad . <br /> 1, 11 1 - i 1, No [3 <br /> Previous Application Made: (If yes,i date--------------------1 No New New Construction: Yes &�No ED FHA/VA: Yes El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public 1.-sewer is available 'within 200 feet.) • 3 <br /> I' ' m foundation_'_.j_,0___'_-�------Material----CO-A _r-------- ................ <br /> Septic Distance from nearest well Dis�ance from <br /> No."of compartments---------I-------- Size"_,_�GI-X---- _--.---Liquid d,p1-th_____"/%-Z-----------Capacity__k--------------- 4 <br /> Dispose u.n ---------Distance to nearest lot line--,.v--- ...... <br /> ;��ielcl: Distance from nearest well._-___ _-_...Distanc�6'from fo clafion <br /> ------------------- <br /> Number of lines-------- ----------i-------------Length of e ------7-,S--- Width of trench---&.3..y '. <br /> Type of filter er mat rial------- "----Total length-------1.,�M---------I----------------- <br /> -eng <br /> 'op <br /> Distance to nearest well-- ___—---------:----Di ante from ou ation_h�---------Distance to nearest lot line__-��`------ <br /> Seep - )' De0th__.?r_-Y_/ <br /> ► Number of pits.-------- Lining� ma erial--- _.Size- Diameter- -------------- <br /> st oundaiion-------------------Lining materiel________________--------�­---------- <br /> ance fro <br /> Cesspool: Distance from nearest well----..__- 'stance <br /> Si 3e -Liquid Capacity---------------------- ---gals. <br /> De ----------------- -------------- <br /> -De ------------ <br /> El Size: Diameter-------------------------- I. , I <br /> Privy: Distance from nearest well-----------=-'{,-:7 ________---_-------------Distance from nearest building------------------------ ------------- <br /> ❑ -7 , <br /> Distance to nearest lot li'he---------- --------------------------------------------------------------------------------- ------------------- ---------------- <br /> Remodeling and/or repairing (describe)------------------7-------I----------- .... ..... . . ........ ................................. <br /> ------------- <br /> --- ------------------------- <br /> -----------I-------------- <br /> --------------tn ------------------- <br /> .....................-------------------------------------- ------------- <br /> ---—-----------­--------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------- ----------------- --------------------------------------------------- <br /> 11 hereby certify that I have prepared this application and that the work will be done!in accordeincie with San Joaquin County <br /> ordinances, State laws, and rules and ' I tions of the San Joaquin Local Health Distric+.. ` <br /> requ a i <br /> tractor) <br /> ---- --- -- -------------------------------(Owner and/or Con <br /> (Signed)---------------- --- ---- ------------ ---------- <br /> ........... ifle)_ <br /> By:---------------------- <br /> P- '-UL-L— ------- 1- ---- --------(Ti <br /> - ----------------- <br /> (Plot plan, showing six of Xn o9di system n relation t;, Iota njp�w <br /> i _to� S. bLu I .,.can b6 paced on reverse side). <br /> 'ng:, 0-Nit <br /> FOR DEPARTMENT USE ONLY <br /> t1C- DATE___________.. ---- -------------------- <br /> APPLICATION ACCEPTED BY____._ -- -------------I -----------­ DATE------------------------------------------i <br /> REVIEWEDBY--_-_---------------- ----------------------------------------------------------------------------- -7....----------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------–-------------------------------------- DATE------------------------------- ---- ---------------- <br /> Alt rations and/or reco en,$ations-.----- ------------------------------I----­-------------­------ -------------- <br /> ----------- ---------------- <br /> ----- ------ <br /> ------------ <br /> -------------------------­--------------------------------- ----------------------------------------------------------- ------#............................... ------------------ /I <br /> -------------------------------------------------------------------------------------------------------------1�- <br /> --------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- -------------------------------- ----L---------------- ------------------------------------------------------ ------ -------------------­--- <br /> --- ----------- ---- ... -------- --------- <br /> FINAL INSPECTIONDate BY: <br /> SAN JOAQUIN LOCAL-HEALTH DISTRICT <br /> /-y <br /> 130 South Amerigan Street 300',Wost Oak Street 1241ye., <br /> 5 West 9th Street <br /> P <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-6Z ATLAS tip <br />