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FOR OFFICE USE: - ------------------------------ <br /> --------------- <br /> -- -- --------------------------- ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------ ------------------------ ------------ (Complete in Duplicate) <br /> ------------------------------- -------------:-------- - - <br /> f'This-Permit E?d:lires 1.Year From Date Issued = Dafe-Issued <br /> Application is hereby made" to the Sari Uoaquin Local Health District for a permit to construct and insfall the work herein described. <br /> This application is made in,,compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION________._ 4n.2-------wd--- ----- ----- <br /> ---------------------------------------- <br /> ------------------------- ---- 4 ---- ------- <br /> Owner's Name------------- <br /> --------------A---------- ---4.Phone------------------------------------ <br /> Address---•------------------41--- 011? a-- V/ <br /> Contractor's Name------ j--------------- ------------------- ------------------------------------------- Phone.Ajvo,.f_5_�kz.(..... <br /> Installation will serve: Residence Apartment House E] Commercial 0 Trailer Court <br /> _] Motel [] Other F] <br /> Number of living units: __/---- Nurnber of bedrooms _3--- Number of baths __2,_._ Lot size ------- -- 24 P` / <br /> ---------------------------------------- <br /> Water Supply: Public system El Community system Z Private El Depth to Water Table <br /> As ft. <br /> Character of soil to a depth of 3 feet: Sand [I Gravel [] Sandy Loam [] Clay Loam E] Clay F] Adobe 2• Hardpan <br /> Previous Application Made:: (If yes,dafe--------------------) No E] New Construction: Yes 59, No D FHA/VA: Yes E] No C <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or cesspool P-ermiffed-if-public sewer is available -within 200 feet.)' <br /> (W <br /> Septic Tank: Distance from nearest well__XA.......Distance from foundation----1-9----- -- Material----&�e J <br /> 0 No. of compartments-------- - -----------Size. id dep�h-----Y..................Capaci <br /> -9-f- 1---------Li <br /> Field: Distance from nearest well- _X6-------Distance from foundation.---/_a____.__-.Distance----------Distance to nearest lot line_..} ....... <br /> ❑ Number of lines---.-----;?n----------------------Length of each line---------`Zr-_`-------------Width of trench.------------------------------- <br /> Type of filter material---dP��A------Depth of filter material____ <br /> ---!_-__---_-Total length-------- ----------------------:7- <br /> Seepage Pit: Distance to nearest well----�o__*_f--------Distance from foundation-__! _- Distance to nearest lot line---J <br /> --- ------- -------------- <br /> ❑ <br /> Number of pits._2?.------------Lining material--- .....S;ze: Diameter...... -------Depth------42_�F.............. ...... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_----------------- Lining material---__.___--_.-________---___---------------------------- <br /> El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------.gals. <br /> Privy: Distance from nearest.well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line--- -------------- <br /> Remodeling and/or repairing (describe}:---------------------•-------------------------------------•----------------------------------- <br /> i <br /> -------------------------I----------------------------------- <br /> ---------------------------------------------------------------------------- --- -------------- --------------------------------------------------------------------A <br /> -----------------------------------------------------------------------------I----------------------------I---------------------------------------------- --------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- <br /> I 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 of the San Joaquin Local Health District. <br /> igned)------­-----------�44----- ----- <br /> ----------------------------------------- -----------------------------------------(Owner and/or Contractor) <br /> By: <br /> -- -------------------------------------------------------------- <br /> - --------(rifle---------- --------------------- --------- <br /> ---------------I;f <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.', can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- <br /> ATE------------M <br /> C 15, ------- ----------------- <br /> REVIEWED BY---------------------------------------------------I------------------------- --------- ------------------------------------- DATE------ <br /> --------------------------------------------- I <br /> ------- ----- --------- <br /> BUILDING PERMIT ISSUED D E <br /> Alterations and/or recommendations:.----/�f e�_�------------ 7 ------- ___1------ <br /> ---------------------------------- <br /> ------------------------------------------------------------------------ - <br /> ----------------------------------------------------------------------------- <br /> - ---------------------------------------------- -------- <br /> -------•---------------------------- ---------------------------------------------------------- ---7---- <br /> ;:_�2 --------- ---------------- -- ----- ------------------------------------------------------------------ <br /> ----------------- --- -----------------­--------------------------------------------------------------- <br /> -------------------------------------------------------------------------- <br /> ------------------------------------------------------------------ --------------------------------- ------------------- ------------------------------------------------ -------- <br /> FINAL INSPECTION BY:..----------- Date-------- -- --------------- --------------- <br /> ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoxeltoii Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockl6n,California Lodi,California Manteca,California <br /> Tracy,California <br /> ES 9 REVISED a-59 3M 3-63 F.P.Ca, <br />