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FOR OFFICE USE: f <br /> 1... ._ : (�..3_....r ..�._�............. APPLICATION FOR SANITATION PERMIT Permit No. .___._____...._ . <br /> j. �f_'Q_ -_--•_-.. (Complete in Duplicate) <br /> y Date Issued -•f�3. <br /> .........______:.......................... . This Permit Expires ] Year From date Issued i <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 Cou4 Ordinance No. 549. <br /> i 1 <br /> JOB ADDRESS AND LOCATION__10.0_.Z._rp._.. __-_ ..c..______________________ _ <br /> Owner's Name....A14eAt..._._...---5�._��X.0.... ...........•-•-•--...-.......................................•........................ Phone.---_..s..----- <br /> Address............/_o..Y_.h-1......... ....Q ..Y..! ..__: _..... ...............................................---------------•---••••-••--•--•....._.... --•-....-..-----•--•_.. <br /> �,lr --------------- �- 6 Phone.f7rd1_`/S Z?:�---• <br /> Contractors Name.._..!-••.= ,__._ -- s�., _,.✓f.--•-----....-------•--•-•--...--•--..._........-•--•---....----.. _ <br /> Installation will serve: .Residence 1!1--Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel .❑ Other ❑ <br /> Number of living units: Number of bedrooms __.. Number of baths _ --. 'Loi size ____-__sy !-- <br /> Water Supply: Public-system ❑ Community system ❑ Private [5—Depth to Water-Table .. ft' . <br /> Character of soil to a depth of 3 feet: Sand ❑ .'Gravel ❑ S Indy Loam❑ Clay Loam [IClay E] Adobe QrHardpan ❑ <br /> Previous Application Made: (If yes,date........... ..:i..._) No New Construction: Yeso ❑ FHA/YA:Yes❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspoolpermitted if public sewer is available within 200 feet.) 1 <br /> Septic Tank: Distance from nearest well... r.._.Distance from foundation_._/ _...........Ma'terial_PY � G"oy+L r�7`� <br /> No. of compartments:. .Size_ ---Liquid d <br /> .e th_ `'.0:...............Ca acit <br /> ../.:?-Ov <br /> Dis osal field: Distance from nearest well.... �-------Distance from foundation.... .........Distance to nearest lot line_.S._e_....._._. <br /> .. <br /> Number of lines........... Length of each line.......7s.�_.��..-_.___.Width of trench....._ ... N <br /> Type of,filter.material...���.k_....-,-Depth of filter material_.._��.__.._..__..Total length.__.._. �:........................ <br /> Seepag It: Distance to nearest.well__/_�`'��.._....Distance from foundation... _!?----------Distance to nearest lot l��s��..____-_ 0 <br /> Number of pits;...._.E.Z.._.....__Lining material...__6. !' A--_.-.Size: Diameter-_--22.��..._____Depth......................:_...._..__ <br /> f <br /> Cesspool: Distance from nearest well......1___....,-Distance from foundation.....................Lining material................_.................... ;t <br /> ❑ Size: Diameter........:------.............---------Depth.....................................................Li uid Ca aci als. <br /> Privy:` Distance from nearest well.......1........................................Distance from nearest building.._..........................._----------- O+ <br /> ❑ Distance to nearest lot line.................•........................... ••-••--•••----•••-----•-••••--•--•••--••--•••--................._............................ f <br /> t 1 <br /> Remodelingand/or repairing (describe): ..............r............................................................................._..-•-•---••---•-----.................................. V 1 <br /> ............................ <br /> ---- ---•--..:.............................•-•....•................•.•----•---- <br /> B <br /> •--......-••-_.. .._...----•--•.--•--__---•-------._..•.........................•-.----•------._..--'--'•--•------•--•---'...•----._........__..._.__....._...._----__....._-•----'•-•-•-•r•--•......:._................... <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 o°f the San Joaquin Local Health District. <br /> (Signed).. .. ..,..._ -----•-- --....__...----•--•-----...-------------------------------- <br /> .__•.---•------••--•----•-• ----------------.(Owner and/or Contractor) <br /> I T'iile <br /> -------------- ---------------------...._...__--•---- <br /> (Plot plan, showing size.of.lot,.Iocafion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> n <br /> APPLICATION ACCEPTED BY.................................. ...................... ........ `v.DATE- r`" ••••--------•----• ------ <br /> _.. <br /> REVlEWEDBY------------- --- ---------------------•• --•--._....------------.._...__.......----..-----------•-._._•------- ........... DATE..................................................-........ <br /> BUILDtNGPERMIT ISSUED--------------_----------- .------• -------- --•-- -------- DATE .................................................. <br /> Alterations and/or recommendations:._.._ . .... : 77 _... •........ �� / ----•--..•----....._.. <br /> . .. l:', 1.. . <br /> -..._..__•..............•-•-.._...._.-.._......_-_.._......_......._..•.•......._....... ---......._f 4Z2_ ;..l �_._.._.,_...-•_-_____•: :::• 4 <br /> --._.......................... ... .... f .. - ---:.::` : k <br /> I, <br /> .:: :._.: <br /> .......................... <br /> ...Il:�:.I.3••....�- .. :::::::::----------------------::::-------::::::------::::.:.:._.... <br /> �y <br /> FINAL INSPECTION BY:._... .......... .� Date....... ...!_l-.- r/... ��.. ......... ------ <br /> ........w-••---. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave. 300 West Oak Street * ` 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> q , <br /> 1 <br /> E5 9 REVISEO B•39 3M 3=53 r.P.CG• 11 ' <br />