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1 <br /> FOR OFF CE E: <br /> t - --------- Permit FOR SANITATION PERMIT Perini+ No. D <br /> --- ----- <br /> {-------------------------------- -------- [Complete in Duplicate) -------- <br /> ---------------------- <br /> ._ <br /> -------------------------------------------------- Date Issued ---�--3---�-r <br /> --_----------_-------------- IThis Permit Expires 1'Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr' <br /> This application is made in compliance with <br /> County Ordinance <br /> ,�Nto`. �549.4- �Vu_` ---. - --•----------------------•------__-----•------- <br /> JOB ADDRESS AND�L,OCATIO - --• --- 1 'Y <br /> .. <br /> - _ Phone------------------------------------ <br /> Owner's Name---- r <br /> Address--------------------------- ------------' 3Q � '� .1_--5-lt7 <br /> •---- Phone_:_._-•-----_--------------- <br /> Contractor's Name._____..�D_6__ --------------------- ------- -- - <br /> _ <br /> El <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: �4omrnunity <br /> umber of bedrooms Z__ Number of baths ._/.. Lot sizeWater Supply: Public system-. system ❑ Private C1 Depth to Water Table -------- ft. <br /> Character of soil to a dep+lt of 3 feet: i Sand ❑ Gravel I] Sandy Loam [:1 .Clay Loam [IClay ❑ Adobe[Rr-_`Hardpan ❑ <br /> Previous Application..Mt ade: (If yes,dot e--------------------I No V-New Gonstruction: Yesto <❑ FHA/VA: Yes ❑ No <br /> TYPE, OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool piprmitted if public sewer is available within 200 feet.) <br /> istance from foundation__ <<1 e �- - ---------- <br /> Septic k: Distance from nearest wefl__''- - _ _____. <br /> f -Ca No. of compartments----------2 -----------Size--------, ---Liquid depth d���t� pacit Y <br /> Disposal Fie d:` Distance from nearest we l-__ Distance from foundativ _. a_____.-----Distance to nearest lot line----------------- <br /> Disposal <br /> - -------- <br /> Number of lines--------------/-----------------=Length of each line------9'-�-----------___-Width of trench ----Z_Xf----------------- <br /> Type of filter material-/�:+t_C--t-:___-_-Depth of filter material__--.1S-_--_--;Total length_____��-�_-__----_-�-7------ <br /> t _ <br /> -- 1 or <br /> Seepage •- Distance to nearest well____________----------Distance from foundation-__________...- Distance to nearest lot line. <br /> :Number of pits------- f---------Lining material---arrt-c--,s_----Size: Diameter------3-3--f'----Depth__4-,:i---1-----­---------- <br /> Cesspool <br /> ---- ------ <br /> Cesspool: Distance from nearest well___--------------Distance from foundation--------------------Lining material--------------------------- <br /> , <br /> ❑ Liquid Capacity------------------------ --gals. <br /> Size: Diameter---j--- '------------ -------�,,--pepth---------------------------------------------------- <br /> Priv Distance from nearest well------------------ ------------------------ -----Distance from nearest building__-______-_-_-.__P_-----------_--------. i <br /> Privy.-' -M <br /> ❑ Distance to nearest lot line--------------- --- - <br /> " <br /> Remodeling and/or repairing (describe):- �i�' - <br /> -------------------•------- --------- <br /> --•-------------------------------- <br /> ------•------------------ <br /> --------------------------- <br /> ------- <br /> - --- •-------------- ---------=----------------------------g-------•------------------------------•q-•------•----------------------- <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 re ulations of the San Joaquin Local Health District" <br /> r <br /> d {Ownerand/or r Contractor) <br /> ----------------------------------------------------------- <br /> By: <br /> -------------- -------- <br /> B ---- ---------------(Title)---- --------------- -------------- <br /> (Plot plan, showin- a <br /> x <br /> of to , location of system in relationells, buildings, etc., can be placed on reverse side). <br /> r <br /> FOR PARTM NT SE ONLY <br /> APPLICATION ACCEPTED BY 5 ------ --------- DATE--------- u� ��,l---- --------------- - <br /> -- --- <br /> 1' REVIEWED BY-------------------------------------------- ------------•-•- DATE.--------------------•-- ...-------- �--------------- <br /> ---------- -- --------------------------------------------------------- <br /> BLIILDING PERMIT ISSUED DATE <br /> Alterations and/or recommendations:--------=----- -------- ----- -----------: ------•=------------------------------------ <br /> --------••--------•-----•---•----------------••------------- <br /> ------------ <br /> ------------ •- ------•----- --------•------ ---------------------------------------- <br /> -� <br /> ._ ---Date ------ J' <br /> ........ -------- ------------------ <br /> FINAL INSPECTION BY:_'_: --= ----- ------ - --- f <br /> -- <br /> z* <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street x;300 West Oak Street 124 sycamore Street 205 West 9th Street <br /> a <br /> Stockton,California '' Lodi,California Manteca,California Tracy,California <br /> i <br /> E9.9 REVIBED e•SA F.P,c O.210 6.613 <br />