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FOR OFFICE USE: <br /> Permit No. .. ..... .. <br /> ---------- ------------------------------ --------- APPLICATION FOR SANITATION PERMIT <br /> ---------------------------------------------- <br /> (Complete in Duplicate) Date.Issued <br /> This Permit Ex ices I Year From Date Issued <br /> — 7 <br /> R <br /> Al-i-cation is hereby made to e n Joaquin Local Health District for a permit to construct and install the work herein described. <br /> pp <br /> ) C ina ce No. 549. <br /> This aF rl <br /> is co <br /> -------- --- <br /> D <br /> JOB AN LOCATION----------------- ---- ------- - - ----- ----------- <br /> ----------------------- <br /> Phone - <br /> . <br /> -------------------------------------------- <br /> Owner <br /> s Name-____ <br /> Address-..-------- - ------------------------------ <br /> Phone----------------------------------- <br /> Contractor's Name---- dal ......... . kt/- <br /> ------ ------- ------------------------------ <br /> Commercial n Trailer Court D motel 0 Other 0 <br /> installation will serve: Residence C�� Apartment House El <br /> i ---------------------ySG ----------------- <br /> Number of living units: .-_l__I_ Number of bedrooms -3---- Number of baths 7777� Lot size <br /> stem 0 Private 2T,�Depth to Water Table -------- ft. <br /> -1 <br /> Wafer Supply. Public.system F1 ',Community system Sandy Loam K Clay Loam [I Clay 0 Adobe 0 Hardpan C3 <br /> Character of soil to a depth of 3 feet: Sand F Gravel El No E] <br /> previous Application Made: (if yes,date--------------------) No n New Construction: Yes [I No El FHA/VA: Yes [I <br /> TYPE OF INSTALLATION AND SPEC IFICATIONS:, . __,-7 - .i6­.�..._.. - ­_ . . - --- _.;� <br /> (No septic tank or Cesspool permitted if public sewer is -available within 200 feet.) <br /> foundation_ ------Material-_A010--.0-------------------------------- <br /> Septic Tank: Distance from nearest ........Distance from - ------41-----------------Capacity--- jz <br /> Ilef!XA. Liquid clep�h <br /> R/ No. of comparfme Is------ from foundation------IV-: Distance to-nearest lot line-4........... <br /> Disposal Field: Distance from nearest well...Rp---------Distance .Width of trench----z'--------------------------- 101 <br /> Number of Imes_.-._____ -----------I----------'Length of each line___.,P��------------------ <br /> M _length_____ --------------------- <br /> of,'f i- -9-'�'--s---Total _I <br /> Type of filter materia!_._-....5A Ite'r' merial---- <br /> -------Distance to nearest lot line__.__-_._..__.._ <br /> Distance to nearest well--­-----------_ _-Disfante from 'founclafio-m- :t77�. <br /> Seepage Pit: I I r- -Yl.SI -----Dept k---------- ---------------------- <br /> F-1 Number of pit's-----------------------Lining material----_-_-_-.--___ ----Size: Diameter.-------------'----- <br /> tq materia----- ---------- -------------------- <br /> Cesspool: Distance from -nearest well____.__._--------Distance from foundation ----- -------- Lining mat ----------------gals. (N <br /> 1; 1 -----Liquid Capacity------------ <br /> Size: Diameter----, .-------------------------------Depth---------------------------- ------------------ <br /> F-1 Distance from nearest building----------------------------------------- <br /> Privy: Distance from nearest well----------------------- - <br /> --------r--------- --- ----- ------------------------------------------------r----------------------------------- <br /> 0 Distance to nearest lot line------- --------- <br /> ------------------------------ <br /> ---------------- <br /> -- ---------------------- <br /> --- ------------------------------ <br /> Remodeling and/or repairing (describb):---------------------- -----------------7------------------ <br /> - I--------------------- - <br /> ------------------------------------------------------------------------ <br /> ------ ------- --------------------------------------------------- <br /> > <br /> ------------------------------------- - <br /> ---------- ------------------------------------------------------------------------------------------- ---- --------------------------- <br /> --------------------------------------------------------------------------- -------------------------------------------- -------------- <br /> L ----------------------------------------------------------------------- <br /> ----------------------------------- ----------------------------------------- that <br /> I theLocal workHeawill be Distrie dontin accordance with San Joaquin County <br /> hereby certify that I have paretplication the San and <br /> ordinances, State laws, and rulespreand �ed gulhis apafions of Joaquin lth c . <br /> ]l t ----------------{wand/or Contractor) <br /> (Signed)-------I------ ----- ------------------- -------- ---------------------------- <br /> ------- -------- ---- <br /> ------------(Title)------------------------ ------- <br /> ----------------------------------------------------------- <br /> By:----------- ---- d on reverse siQ. <br /> F - . n be place <br /> d tion of sy em in relation to wells, buildings, etc. ca <br /> (Plot plan. showing size of lot, loca <br /> L FOR DEPARTMENT USE ONLY DATE....... --------- ---------------- <br /> APPLICATION ACCEPTED BYA----------t__ -- - ------- ------------------ <br /> --------------- <br /> -- DATE_---------- --------------------------------------------- <br /> - <br /> REVIEWEDBY----------------------------`- ---------- ------------------------------ --------- DATE.- -_---------- ------------------------------------------I -- --- ------- -------- -- --------------- <br /> BUILDING PERMIT ISSUED--_---._`--------- --------------- ---- ------------ <br /> - ----- - -- <br /> Alterations and/or recommendations:------------------------_--------------- --------------------------------------------------------- --------------------------------------------- <br /> ------------------------------------- ------ --------------------- ------- -------------I---------------- -------- ------------------------------------------------------------ <br /> --------------- ....... <br /> ----- ---------------- ------- ------------------------------------- <br /> ----------------I-------------------I----------------I---------- --------------- ------------------------------------- ------------ ------------------ --------------------------- <br /> ----------- ---------------------- <br /> --------------- ---------- ----- -----­----------------- ----------------------------------- ----------- --------------I---------------- ---------------------- <br /> ----------------------------------------- <br /> -------------- ------ -------------------I -------- -------------------------------- ---------------------- <br /> ------------- <br /> Date------- ------------- --------- <br /> FINAL INSPECTION BY:_--- ---- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Kaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> j­� Manteca,California Tracy,California <br /> Stockton,catifornic Lodi,California <br /> F.R.00. <br />