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FO <br /> jrOFF-1 USE: <br />-------------------------------------------------- ...... . <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------------:----------------- <br /> (Complete in Duplicate) <br /> ATi <br /> --------------------------------------- Date Issued <br /> This Permit Exeires 1 Year,From Date Issued e, <br />-----------------------—----------------- <br /> Application is hereby made to the San 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. 1\414 N T ECM <br /> W?Mv- `_c_/ ...... ------RP-.!------------ <br /> �OB ADDRESS AND LOCATION........... 65� __ _0 " A <br /> ---------------------7P c(ne... <br /> Owner's Name........ --------Fvsa V12-------------------------------------- ---------- /..... <br /> ........................•-•------------------------------------------ <br /> Address.............. ..... ..........70............ZM96'r-t—ace---_----------_-------- <br /> Phone.................. ------- <br /> Contractor s. Name./MuTfKA---- ...760K---:5jFEfx 11 <br /> Instillafion'will serve: Residence [] Apartment House [I Commercial [] Trailer Court []N Motel,[3 Other <br /> r of living units:�� Number of bedrooms Number of baths _�. Lot size -----X..Zar_mt.............. <br /> Numbe" <br /> Community system 9�4,rivate El Depth to Water Table <br /> Water Supply: Public system 0 'l . Adobe 0 Hardpan 0 <br /> Character of soil to a depth of 3 fee+: Sand �XGravel 0 Sa dy Loam evClay Loam C]—.cay,0 <br /> date"__.___.- No �7,New Construction: Yes FHA/VA. Yes [I <br /> No <br /> Previous Application Made: (If yes, ------- -----­­. <br /> TYPE __0F INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) A . <br /> Septic nearest well---570------Distance from foundation__._ ---------_-__.Maters lJPP3___­..........om'.................... <br /> Tank: Distance from ne F Capacity_,/�K5�Q <br /> No. of compartments....... 25-10---Liquid clep�h-------- -------------- <br /> • ........... ....Si,e.5 ---- — <br /> Disposal Field: Distance from nearest well----5 _.Distance from found"ation._/0.......Distance to nearest lot line._._------- <br /> -Number of lines__.-.------21__ ---------------Length of each line__-____ Cd-____------.Width of trench.____.-- ........ <br /> Type of filter material.,4R ....Total length___________________.06 -- -----Depth of filter material. <br /> Seepage Pit: Distance tonearestwell---------_------ ----Distance.from foundation....................Distance to nearest lot line <br /> ❑ Number o4,,pits `-----------------LieLining material_-__��'_'--------:Size: Diameter------------------------Depth----- --------------------------- <br /> 1-41� <br /> Cesspool: Distance-from-,nearest-well:_tn <br /> _Distance from foundation-------------------"Lining material_-_____-...____-___..._._._...__...._ <br /> C3 Size: Diameter------------------------------ --------Depth----------------------------------------------------Licluid'Capadity---------_•---------------gals. <br /> Privy- Distance from nearest well-------- ------.-----Distance from nearest building --------------------------------- <br /> --------------------------- <br /> -----------------------------------------------------I--------- <br /> Di❑ stance to nearest lot line---1 ----------------------------------------- <br /> ti <br /> --------------j-------i------------------------------------------------------------- -------------------------------------------..................... <br /> Remodeling and/or repairing (desci ------------- <br /> I -----I--------------------------------------------------------------------------I-----------------------------11---------- <br /> -----------I----------- ...... ------- <br /> ...........--­-------------------------------------­---- <br /> -----------------­--------------------------------------------------------------------------....................... <br /> -------------------------------------------------------------------------------- •- t <br /> ----------------------------------- <br /> ------------------------------------------------------­--------------- ---------------------------------------------------------------------------------------------- <br /> ---------I hereby certify fha+_1_have-prepar d this application and,that-theL work will be done in accordance with San Joaquin County <br /> gul ions of the San Joaquin Locil Health District. <br /> ordinances, Ste laws and rules an A <br /> Owner and4or ontractor)_. <br /> ------------- --------------------------- <br /> qne;l)------- <br /> By:_-----------------­!---------------- ------------------------------------------ <br /> ---------------------------------..............(Title)------------------------------------------- ------- <br /> tf <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed..on reverse side). <br /> FOR DEPARTMENT USE ONLY li <br /> DATE---------S <br /> APPLICATION ACCEPTED BY----.----I ------------- ........---------- DATE-------------------------------- ....................------ <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------- <br /> ----- <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------–--------------_- ---------- DATE-------------------------------------- --------------- <br /> ----- <br /> ---------------------------------------------------------------------- <br /> Alterations and/or-recommendations:_---.-f_- --------------------•-t:-- ------------ <br /> ,mss <br /> -----------t---------1st!!........ ----------­--------.-•----•-----••---•--•-•--•----•-------... ----­------ ----------- <br /> --------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------ <br /> - <br /> --------:...... <br /> /1' ------------------------------------------------_-------- <br /> ..... -------­----------- -----)--------wl��------------------------------------------------------ <br /> ------------ ------------------------- <br /> --- ---- IA-------------------------------------------------------------------------- -------------................... <br /> ---- -----(A <br /> ---------- ---------------- ---- .... <br /> Date------------------6/717_42 ------ ------------------ <br /> FINAL INSPECT40Uj_y - - -- ------------------- -- - - <br /> DISTRICT <br /> SAN JOAQUIN LOCAL HEALTH <br /> 124 Sycamore Street 205 west 9th Street <br /> 130 South Arnerican Street 300 West Clak Street Manteca,California Tracy,California <br /> Stockton,California Lodi,California <br /> ES �rvtrv) 9-a9 2M B-61 ATLAS <br />