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rvKVrrlC.t Jt: <br /> - _____ _ _� ---------- APPLICATION FOR SANITATION PERMIT Permit Nojr.. _4..._:.�, <br />------------�!`� �- > G' - ----- (Complete in Duplicate) �� I <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issue f'� <br /> Application is hereb•�- i J <br /> pp ;i ,made to the San Joaquin Local Health District for a permit to construdt and i3 1 the workherein described. <br /> This applicatioli iernade in compliance with County Ordinance.No. 44. j cj <br /> 0._ u �� �f� r"� <br /> JOB ADDRESS AND <br /> L TION__ / 1'- ------------ <br /> Address <br /> ' f �'�?rGfy-(f ,u .vL <br /> r <br /> Owner's Name.-_______ �. <br /> .1/ <br /> Address. .......................................... •--• ---•- ---- ------------------------- <br /> Contractor's Name � -----------------------------•---•-... �` Phone........... <br /> Installation will serve: Residence partment Haus0 Commercial 0 Trail Court ❑ Mot�l '❑ Other ❑ <br /> Number of living units: .___ Number of bedrooms.-__- Number of bathsf-�e.Lot size : <br /> •------•-•------•••--- <br /> Water Supply: Public.system ❑ Communify system ❑ Private gj"Septh to Water Table .,AP4. a� <br /> Character of soil io a depth of.'3 feet:' Sand Ej Gravel ❑ Sandy Loam ❑ Clay Darn ❑ Clay [] Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,dote----------- --). No,Qq­' New Construction: Yes 9?"06 ❑ FHA/VA: Yes Z?No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICAt,IONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ' Distance <br /> n tom arteares_f__ �p• Distance from foundation ZA[_________.Mafierial__G�_�r-� �•.• <br /> Septic Tank: Dis#encs from nearest � II___ •Size_ ._____ <br /> --. .,Wf ", 1. dll`i aid de th_.__ <br /> Disposal Field:' Distance from nee st..-well__ `__..-_Distance from foundation�� __...Distance to nearest lot line. +, <br /> Number of lines_:____0�_ Length of each line_ __ _-Width of trench_ .______.---.-•--------------- f <br /> Type of filter material._ _y/ '_ epth of filter material_/r_--'_'_1,__ _Total length______ __________________ <br /> . . <br /> Seepage Pit: Distance to negres well_-_4Q0-------Distance om fo ndation--- .__.. is ante to nearest I t line-4........... <br /> fi <br /> Number of ts__ ___-----------Lining material. Q _.-Size: diameter_ ..._..-..._.,Depth_ ' <br /> -------------- <br /> , <br /> Cesspool: 'Distance from nearest well_________________Distance from foundation--------'.-----------Lining material________________________--- <br /> ❑ Size: Diameter------------------------------------...Depth----------------------------------------S-?,_--------Liquid Capacity- •---------------------gals. �I <br /> Privy: Dis#arics�rom_:nea.est well-__.__`_ ____—.__-__--__--- --- Distance.from nearest building <br /> -------------------------------- <br /> ❑ Distance tb nearest lot line------------------------------------------------------------ '-'`-�- ---------------------A�_ _ <br /> € L' ; ---••-----•---------•--•----•--- <br /> " <br /> Remodeling and/9r repairing (describe):--------- -- -------se, . = -� <br /> i - <br /> ---•-----•----------------------------•--------...........................=---_--•----------------•------------------------------------------•- -•-----=----------�----•'•-•----.--••---------=---------- �-- <br /> �, <br /> r ---•••-•#-=--•-•-••--•-------------- ----------------- <br /> --------------------------------------*......4-----------------------------------------•----------•--------___-----------------•--- ------------------------------------------- --------------------------- <br /> hereby certify that I have .prepared this application.-and-that+he-work-will-he-done-in-accordance with San Joaquin County <br /> ordinances, State laws, an rules and regal tions of the San Joaquin Local Health District. <br /> (Signed) <br /> --,---------- ------ r Contractor) <br /> ,4 , . <br /> BY: ••. --------------------(Ti+le]. ---------- --------------- <br /> (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). \ <br /> T <br /> FOR'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ --- — --------- - - --- - ------------------------------------•----- DATE..... .. <br /> REVIEWEDBY------------------------------------------------ ................. DATE------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------—----------------••-_—. ------------- DATE-------•-----•-•--••------------------•-• - <br /> Alterations and/or recommendations:-----------------------------------------------------------------------------------------------•---... -------- <br /> ---------------- <br /> ------._... <br /> ---------------:�_. � -----------•--•-•.•----------------------------------••------------------------------•---------•- <br /> -- ----- ---- - <br /> ....- - ------------- <br /> FINAL INSPECTION BY. -------- --- ----- - --- -- ---------------- Date ... -Z... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Zl 130 South American Street 300 W fst.Oak St»et 34,Sycamore Street 205 West 9th Street <br /> Stockton,CiiliForn'16. _�+ lodl,California Mantecv;w � ` <br /> CliFornla Tracy,California <br /> EB 9 REVISED B-59 eM 5-61 ATLAS • - <br /> A <br /> , <br /> = a <br />