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FOR OFFICE USE: "4Z <br /> . mac• G L "-�-�. Permit No. A_4_3-7,-4----- <br /> -'- -__-- APPLICATION FOR SANITATION PERMIT <br />-------- = = (Complete in 1)u licate -- <br /> T t p Date Issued . _... F N-- . <br />-------- <br /> - --.--, �This Permit Expires 1 Year From Date Issue <br />--------- --- ------ -------------- -------------- <br /> is hereby made to the San Joaquin Local Health District fora:permit to construct and install the work herein descrbed. <br /> This application is made in compliance with County Ordinance No. 549. { <br /> ---•••-•-•--CIC544 -4_� <br /> JOB ADDRESS AND LOCATION--------------- ------------Z . <br /> -----------------• Phone.---•-----------••----•------------ <br /> Owner's ame__-------------------------- -- ---- <br /> ---- ---------•-------•-- =_ <br /> Address--------------- <br /> Contractor's Name------- Phone-----•--••-------------•--•----•-•• <br /> _ ------------•-------•--------------- <br /> --------•----------- ��-�---`�' -^�'''---------- Motel ❑ Other ❑ <br /> Trailer Court ❑ <br /> Ins+ally+ion will serve: Residence 0 Apartment House ❑ Commercial [3 .: <br /> Number of living units: _� <br /> Number of bedrooms - Number of baths�_-- Lot size ..__ - �' " -••••- <br /> Water Supply: Public system ❑ Community system ❑ Privatq�g Depth to Water TableAdobe❑ Hardpan C]Gravel ❑ Sandy Loam® Clay Loam Clay <br /> Character of soil to a depth of 3 feel: Sand F1Y <br /> Previous Application Made: (If yes,date___-__-------------) No�` New Construction: Yes No ❑ FHA/VA: es ❑ N � O <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material_____________------------------------------------ <br /> Septic <br /> ________ ' <br /> Septic Tank- Distance from nearest well_________________Distance from foundation__.___.___..___.___. <br /> •---••----•--••------- <br /> No. of compartments-•------- ----••-Size---------------•--------•--- -Liquid depth Capacity .� <br /> Disposal Field: Distance from nearest welL____ y -Distance from foundation_..__.'' .-`---•Distance to nearest lot line................. <br /> (' Width of trench.. ..._ . <br /> Number of lines._.---___.�___ _______ Length of each line ---•_�-- � �� <br /> Type of filter material.._.��' �----Depth of filter matenal-._.l_,I"-_ilength <br /> Distance from foundation___________________Distancetonearest lot line---.......... <br /> :.._ <br /> Seepage Pit: Distance to nearest well--------------- ,Depth--.---------------•----••-------- <br /> ❑ Number of pits_.:___..--••---•------Lining material---------------•--.-•--.Size: Diameter---.-.----------------- <br /> Cesspool: Distance from nearest well-------------- from foundation---._._-___-_ ._'!Lining material----------.----------.----.__..._alS <br /> Depth__._. =� Liquid Capacity--------------•----•---•--- <br /> ❑ Size: Diameter--------------------------------- <br /> _--Distance from nearest building-------------------••--------------- __. <br /> 4 Privy: Distance from nearest well---------------- ----- --------- ---------____------ <br /> �- e • _ +" <br /> : =----------••-•----•---------..--•:- <br /> i ❑ pisTance to nearestfot line__.___.-_.._ <br /> -----------------•---------------.-.---------••- <br /> i Remodeling and/or repairing (describe):-----------------------------------------•--•---••------- = ; ------------•--- -- <br /> If ------ ---•----------•-----------•----•----------------•---•--------•--------------------- ' .. <br /> -• ..--------••-•---------------•----------------------------- -01 _m. li -------- -------- <br /> . '�. <br /> ` •------------------ _ - ------- -- --------•--------•--- <br /> I �» - sra,,f-'-------------••-------•-------. --------•-------•--------- = <br /> t,. ---------------•-------------•;--- ------ ; <br /> 1 I hereby certify that I have prepared is -ri nd-thaf+he work will be done in accordance with Sen Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Locl Health District. <br /> 1 r ! <br /> " - - - ----•------- ---------r--------------(Owner and/or Contractor) <br /> �1 .� <br /> (signed} --:, ........ ,- `� r+la -� <br /> - <br /> i By:----------— .c3.n. •... . -- r <br /> (Plot plan, showing size of lat,�loc6tion of system m relatton..,+o,wells, build gs�etch can be placed on reverse side(. f <br /> t FO SPAR <br /> JCY <br /> NT U5EOl "- ' ' <br /> y <br /> -----•u---------- � DATE---•---�..-----�--�=-�--�. <br /> APPLICATION ACCEPTED BY___ .__ <br /> ------------- <br /> ---•-�----t--,.. ...,�,,....:..�.--- --------•------------=--••--------•-------• DATE-------------------------.....---...---•--------•-----'--.. <br /> ----- t <br /> REVIEWED BY. = =:---- DATE------------------­---------- -•------ <br /> BUILDING PERMIT ISSUED---•-•-•-- ;-------¢-•--------•------------ --------------------------------•----------- -------- ........ <br /> i <br /> Alterations and/or recommendations--------••----- ----- <br /> - �,� -- - <br /> --••--•-•---- --••---• -------•-•-_... --- <br /> _ l _ ---- - -- -------- <br /> _ f <br /> M It <br /> i - <br /> ----------- <br /> ------------------ ----- ------- :• ..._..- jj <br /> T�i <br /> p�J <br /> FINAL INSPECTION B .. --•-•--- - -- - --- ----------- - <br /> Date_..-•--------•---- --- -- -6- ---•---------•----'- <br /> 5A*4jOAQUI OVAL HEALTH DISTRICT, <br /> 300 Wast Oak Street k 124 sycamore Street <br /> 205 West Stir Street <br /> l 130SouthAmerican Straef Manteca,California Tracyr California <br /> - <br /> Stockton, <br /> on,California Lodi,California <br /> i ti3"9'�REV45En 8.94 2M 5-6r ATLAS ✓ <br />