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FOROFFICE USE: <br /> -------- <br /> - ---- ----- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------------------------------------- <br /> -------------------------- ------------------------- (Complete in Duplicate)' Date lssue&i---r"Ll, <br /> ----------­------ ------------------------------------ This Permit Expires 1 Year From Date Issued �/� <br /> 0 0 <br /> App lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr ed. <br /> This application is made in compliance with %c"t iOrdinance No. 549. <br /> JOB ADDRESS AND H 10-VI- 10-T-i - --------3 ------- Af---------------------- <br /> J__PCATIO <br /> g7A <br /> -----7j.1v <br /> 7_ -------------4--------------- ------------------- <br /> Owner's Name----------& , � _/---R ------ -------------- Phone-179---3-2-23 3 <br /> Address-----•--- <br /> Contractor's Name----<:A_R6r_1_=--------R---------------------------------------------------------- ------------ Phone.. <br /> --------------- -------- <br /> Installation will serve: Residence [g Apartment House;[:] Commercial [-] Tra'iler Court E] Motel El Other Ll <br /> Number of living units: -t_ Number of bedrooms Number of"baths 2--- Lot-size A - ____________________ <br /> Water Supply: Public system El Community system E] Private Ej Depth to,Water Table ft. <br /> Character of soil to a depth of 3 feet: SanclM Gravel E] Sandy Loam ❑ Clay Loam,E].-,'I.Clay 0 Adobe I-] Hardpan 0 <br /> Previous Application Made: (if yes,date____________ ______.) No New C034'truction: Yes'JO No ET' FHA/VA: Yes El NoiE�' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> -.4r(No septic Jank.or cesspool permitted1f public sewer,.is available within 2.00 feet.). ..1 <br /> Septic Tank: Distance from nearest well.._._:__-.-_-____Distance from foundation-----------------_...Maferiai----------- <br /> T No. of compartments------------------------- Size------------------- ---._Liquid depth--------------------•--- Capacify----------------------- <br /> 0.......Distance from foundation--- -------Distance to n'earest lot line_____,___.. <br /> Disposal Field: Distance from nearest well.Y <br /> Number of iines------------ Length of each line---/6___ ---347' 7Width of trench.-,t--- <br /> ---------- <br /> Type of filter material---- _V__C)-_'e,_.Depfh of filfer material---- _.___Tota� length--------------_5�/ ,-p--------------- - <br /> Distance to nearest well____................:Distance Distan-te from foundation_______________.__- Distance to nearest lof"Ame--------------- 4 <br /> Seepage Pit: i <br /> E❑1 Number of pits--------- ------Lining material------------- ---------Size: Diameter----------.---;-_- ---- Depth---- -------- <br /> ---- --- <br /> Cesspool: - Distance from nearest well-----------------Distance from founclafian--------------------Lining material-_.'01P--------------------.Liquid Capacity :-gals. <br /> --------- <br /> ---- --- _------------------------ <br /> El Size: Diameter-------------------------------------Depth-----------------I----------------------- <br /> -- <br /> Privy: Distance from nearest well------r------------------------------------------Distance from nearest building.._.-_-_-__----._____--__.__-.-_.______-. <br /> ❑ "'• Distance <br /> uilding----------------------------------------- <br /> Distance to nearest lot line--,-- <br /> Remodeling and/or repairing (describe): -------------- ------------------------------------------------------------------------------- ---------------------------------------------------- <br /> ------------------------------------------I--------------:-------------------------------------------------------------------------- <br /> -- --------------- <br /> --------------------------------------------------------------------------- <br /> ----------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------1----------------------___------- ---------------------------------------------_:------------------------------------- <br /> ----------------- ------------------------------------------------- ------ ...... <br /> I.hereby certify that I have pf6pared this applicafiori'a' nd that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rule nd regulations of the San Joaquin Local'Health District. <br /> RZ ---------------------------------------------------------- ---------------------------(Owner and/or Contractor) <br /> SignW.k. -- ------- <br /> 6y:----- -------------------------------------------------------------------------------------------------------------------- (Title)-- <br /> (Plot plan, Aowing size of lot, locationq of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------77TA-o ---------- --------------------------------------------------------- DATE ------ -- <br /> ------- <br /> -- <br /> REVIEWEDBY---------------------------------------- .......... -------------------_2----------------------------------- ------------------ DATE------- <br /> BUILDING <br /> ATE-------BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE <br /> Alterations and/or recommendations:------- ------ -- <br /> ---- --------------­------------------------------------------------ <br /> -----------------------------------------------------Z$y -----Cb. .. -------05-IEF- <br /> rnRlf�---------- ------Ti- <br /> ---------------I----------------------------------- ------------ --------- - - -- ----------- ----------------------------------------------------------- ---------- <br /> -------------------------------------------- <br /> ----------------------- ---------------------------------:----------------------------------------------------------------------- <br /> ---------------------- <br /> _-----------------1------ - .. . ............... -- - -- - --- --- ..- <br /> -------------------- --------------------------------- - ---------------------- - ------------------------------------ ------- --------------- ------------------------- <br /> FINAL INSPECTIO <br /> - - --- ----- -- --- - ------------ Date_------ ------7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California' Tracy,California <br />