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S7 <br /> FOR OFFICE USE: <br /> -------------1-0-- <br /> I APPLICATION FOR SANITATION PERMIT Permit No. <br /> - ------------------------------------------------------- <br /> .1 ....... <br /> ----- - ----------------------------- - <br /> A- (Complete in Duplicate) Date issued .. <br /> ----- - This Permit Expires I Year From Date Issued <br /> -------- ------------ -------------- ------- <br /> Application is hereby made to the S;n Joaquin Local Health District for 6 permit to construct and 'install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549: <br /> ----------------------------------------------------------------------------- ---------------I------------ <br /> JOB ADDRESS AND L C - -c il I <br /> Owner's Name.... <br /> I . ------ -------------------------*--------------------I-------------------------------------­-- --------- Phone------------------------------------- <br /> ----------------------------------------- <br /> Address_-_-_."- <br /> ---------------- ------------------------------------------------ <br /> -- ----------- ------------- <br /> ------------------- Phone----------------------------------- <br /> Contractor's Name----------- ....4-11- - ------- ---- ---------------------------------­­----------�: 1 <br /> Installation will serve: ,Residence ®impartment House-0 Commercial 0 Trailer Court 0 Motel Ej Other 0 <br /> Number of living units:._,___'Number of bedrooms Number of baths/-.---- Lot size _4 _4 ------- ------------------------------ <br /> Public- <br /> Water Supply: ';-Ysfem'L5 'Community system 0 Private ❑ Depth to Water Table <br /> Cl <br /> b - Er- <br /> Character of soil to a depth of 3 feei t: "Sand [] Gravel E] r Sandy Loam 0, Clay Loam [I ay 0 Adobe Hardpan q <br /> 0 --No [I FHA/VA; Yes g;--No El <br /> Previous Application Made: (If yes date_---"--------------- No pj-`1qqw Constructi n: Yes g4 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 'ermi <br /> -from foundation___ ----Mafe <br /> 'Jon--- <br /> Septic Tank: Distance from nearest well_________-_--.---Distance liquid dep�h__-,*-'-r,. -------- <br /> N ' of compartments------A . �'i,e,;GV-, Capacity <br /> 0. 4 ------------------S ., -4V- I_0 - <br /> Disposal Field: Distance from nearest well_ -_—--------Distance from foundation-"- Distance to nearest lot line--1.17-.1---- <br /> Number of lines Length of each line___---. 0I <br /> _'-----------Width of trench__ <br /> ----Total length------ -------I--------------- <br /> al---- <br /> Type; of filter �n`afe ia Depth of filter materi <br /> T Distance to nearest lot line" --""------ <br /> Seepage;Pit: Distance to nettresf'well---------- ------- <br /> Distance f am founda <br /> tion--Z-" <br /> *If f - <br /> Size: Diameter_.�u-------_---Depth_-, ------------------ <br /> Number of pit's--- -------------Lining material, __.S <br /> I <br /> n--------------------Lining material__.._...._____.._.__:.._________..___ <br /> Cesspool- Distance from nearest well--------------- Distance from f6undatio <br /> 11 F � ,-�a ---Liquid Capacity------------­--------------gals. <br /> Size: Diameter:----------'-------------------------Depth--•-•---_7.---------------------------------- <br /> Privy: Distance from nearest well------ ------------------------------------- <br /> ----Distance from nearest building--------------------•----=----------,------ <br /> Distance <br /> -------------------- ----------------- <br /> Distance to nearest lot line-------------------------------------------- ----- ---------------------------------------------------- <br /> Remodeling and/or repairing --------I----------------- <br /> ------------------ ------ <br /> --------------I--------------------L ---- <br /> ---- -- <br /> ----------------------------------------------- - ------I,-------------------------------------------- -------------- <br /> ---------------------------------- <br /> 1 - . . I -------------------------------- --------------------------------I---------------------- <br /> ----------------------------------------- ----------------------------------------------------------------------- <br /> q. % ------------------------------------------ ------------------------------------------------- ------ <br /> - <br /> ----------------------------------- ----------------------------- ---­­--------------------:----------- <br /> 1-hereby certify that I have -prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the,San Joaquin Local Health District.. <br /> itQAmr:jROor Contractor) <br /> (Signed)------------------------ - ------ ------- ------- ------- ----- ....... ------------------------------------------ <br /> ------------{Title] <br /> -------------- <br /> By:-------------------------------------------------- ---------------- --- - -- --------------- <br /> (Plot plan, showing size of lot, location of syste relation-to-w- 'blls. buildings;ate., can .be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ^CCEPTED 13Y___-!_C__4------ ------------------ ----------------- ------------------ ----------------------- DATE---- ---------------- <br /> ------------- DATE------------------------------------------------------------ <br /> REVIEWEDBY--------------------------------------------------------- j, <br /> BUILDING PERMIT ISSUED_____-------------------------------------------------------------------------------------I----------- DATE---------------------------------------------- -------------- <br /> des <br /> Alterations and/or recommendations:---- -------- ----—------- .......n.e­------- <br /> --------------------------------------------------------------------------------•-----------------•---------------•---------• -------------- <br /> ---------------------------------------------------------------------------------- <br /> H ---------------------------- -------------------------------------------------------------------------------- <br /> ---------------- --------------------------------------7---------------------------------- ------------- <br /> ------------------------------------------------------------------------- --------------------------------------------------------------------------- ------*----------­------------------------------- <br /> --------- -----------------------------------­------------------------------------------------------------- <br /> ------ ------- ---- ---------------------- --------- <br /> ----- ----------- ---------- <br /> FINAL INSPECTION BY:------------------- - - L----- ---I-------­ <br /> Date---.A --------------------------------------- ------- <br /> - -----------------:--------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 west Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodl,California Manteca,Cc I lfo�rnlc.\ Tracy,California <br /> E9-9 REVISED 6-59 r,P-CD-ZM.6-6p <br />