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FOR OFFICE USE: <br /> ------------�:------- <br /> III <br /> ----------------------- ---- -- <br /> ...... ----------------------------- --------- 'APPLICATION FOR SANITATION PERMIT Permit No. ,&. <br /> -------------------- <br /> (Complete-in Duplicate) <br /> .............*F------ ----------------------------- This Permit Expires 1 Year From Date Issued Date-Issued <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 County Ordinance,No. 549. <br /> 1 -- -------- ------- I <br /> JOB ADDRESS Aa !� & ;,, 7----- - --- ---- - -------------------------------------------------------------- <br /> Owner's Name-----A 7�A-Ti- -.1. 1 <br /> . ...... . ----------- --- ----- - - -- ---------- ------ - - - -- ---- ------- --------------Phone4o-'r <br /> Adcltess--------------------------- .. .............;__ <br /> Contractor's Name----- - --- - - - ----------- -< <br /> Installation will serve: Residence Apartmerif House ❑ Commercial. F1 Trailer Court Motel ❑ Other E] <br /> Number of living units: _11" 'Number of bedrooms �_ umber of baths __"VLof size ---- ------------------- <br /> Wafer Supply: Public system K <br /> Community system E] Private E] Depth to Water Table 76_ ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] . Sandy Loam [-] Clay Loam El Clay El Adobeig Hardpan El <br /> f <br /> Previous Application Made: (If yes,jate-----------7------- ) No New Construction: Yes E] No FHA/VA: Yes F] NoK <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic,+ank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: -6istiance from ne'arest 6�izk)ONAEDisfance frolm foundation.. . . .........Material.'.. <br /> ........ <br /> No!Of comport mentaa c i <br /> -------Liquid depth.S7 <br /> _-_._._..Distance to nearest lot <br /> Disposal Field: Distance from nearest well I)19 -Distance from founclafion-Za- <br /> Number of lines. _ _ .._ e---A....Length of each Jine-.7—S-74 -------Width of <br /> Type of filter ma'ferial----- --Depth of filter material-----L ------Total length-.__, ,�---.-----_­---- -----17 <br /> Seepage Pit: Distance to nearest well-_/0-00-0......DisfamfeRom f0ridation-0-----------Distance to nearest lot line_..��—.____Q <br /> Number-of pits-C-.1----\ 9 - -_ -------- <br /> 54 ,-- - -- Lining material #CO3&,K,, Size: Diameter__4V'_._.---D,pfh_A.,G7:4_ -_ <br /> Cesspool.' Distance from nearest well ----------------Distance from foundation.___....____.___ - Lining material------------------------------------ <br /> F1 S-�z e: : --------- ----- -------- id Capacity---------------------- -----gals. <br /> Diameter- A --------Depth--------- --- - - ---------------------------11---:..Liqu_ <br /> .1 1 <br /> Privy-. Distance from nbaresf well------ ---- - ---------- - ------ --------------Distance from nearest building.--..___-----._-----_--..____..._.-._--... <br /> ❑ Dista ce <br /> uilding.---------------------------------------- <br /> DLisfance to nearest lot line .......... --- <br /> a------- - ------------ <br /> --- ----------6 <br /> -------A­, 15t�:- -------- <br /> ------------------------------------- -------------- <br /> ---------1-1-------------------------------------------------- <br /> Remodeling and/or repairing (describe):------ ------------ --- ------------------------------ <br /> __--_-__.__•-----------------------------------------_.___ --------------------- ------------------------------------------------------------------------------------------- -- <br /> - --------------------------------------- <br /> I------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- <br /> ------------------------------------------------ ----------- --------- ------------------------------------------------------------------------------------ ------------------------------ ---------------------_------ <br /> I hereby certify that t av prepared this be done in accordance with San Joaquin County <br /> ap <br /> ,plicaflon and that the k will <br /> ordinances. State laws, d r s and of the San Joaquin L coal Health District. <br /> (Signed)------------------------- -- ------- - -- ------- ---------- --- -- -- ---- --- ----------- ---------;=--' --------- ---- ---- -- ---(Owner and/or Contractor) <br /> By:--------------------------------- ----- --- ------- -- --- - - -- - --------------- ----------- <br /> ---(P(Plot <br /> lot plan, showing size of lot,=ocation of system in relafio o wells, buildings, efc., can be lac on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ------------------------------------ ------------------- DATE--- --- ---- -- <br /> REVIEWEDBY------------------------------- ------------------------------- <br /> --------------- ----------------------- DATE----- --------- <br /> BUILDING PERMIT ISSUED-------- ------------ --------- DATE-... - _ - ------------------ <br /> ! <br /> I- ------------- <br /> --\--------------------I-- -------------- __1 <br /> Alterations and/or recommendation :1 0 C ----------- - ------------ <br /> --- ------- - ----------------- <br /> ------------------------------- -- <br /> - __671--- I--- -- -- - ---- ------------------------------------------------------------------------------------ <br /> -- - --------------------------------------------- <br /> ------------------------ ------------------------ ------ ------=-'- ----------------------------------------------------------------- --------------------------------- --------- -------------'----------------------------- <br /> I <br /> -------------------------------------------------------- -------- -------------------------------------------------------- - ------------------------------ - ----- --­­ ­­------------------------ <br /> ................................. ............. ------------- ------------ --------------- -------------------------------- ------ ------- -------------- <br /> FINAL INSPECTION BY--.__Jq.�. 2! <br /> ...... . --- <br /> .... ------------ --------------------------- Date.... .. <br /> ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />