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FOR OFFICE USE: <br /> '5 <br /> _________________,___.____--.- __ ________________-__. APPLICATION FOR SANITATION PERMIT Pedmif Nat ..7.. 'S <br /> - - <br /> y,«, .� Date Issued <br /> (Complete in Duplicate) <br /> ' <br /> This ---- <br /> Permit Expires 1 Year From 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 /> JOB ADDRESS AN LCATI N.v�.�s® <br /> .� X � <br /> f•. <br /> Owner's Name --- ---------- Phone <br /> S' y <br /> Add ress---•ci? . ------- <br /> Contractor's Name .v�a,1 Phone.................------•---..... . <br /> .___ _ .____�... .�^_�.�{_. .... --- -------------- ------d_ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ���-�-�"'�'� <br /> Number of living units: -------- Number of-bedrooms -------- Number o baths --_ Lot size __---a- --__--.-- --- _ <br /> Water Supply: Public system E] Community system El Private Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: E Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_-.------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)` <br /> p f Size- e: - - f ndat n ----6f--P----.Mate ial--�h�� --•------- ------ <br /> Se tic ank: Not of compartmentst well _ __.___Dis#ante fry„f Liquid depth_____.............Capacity_..�d. . <br /> : ' r�° -- <br /> Dis os Field: Distance from nearest well_-�.E�_-._.Distance from foundation_.__/&----- to nearest lot line_S_-_______ t,J <br /> p' 5_ s <br /> Number of lines----------_._... .. - Length of each line_______JQ_ _`Q___.Width of trench__.�__o__._.___...,____.. <br /> Type of filter material. ___.Depth of filter material----..A�°_ _ g __ __....... <br /> � <br /> .Total length �________.___ <br /> See pa Pit: Distance to nearest well------` u`._------Distance fr m ndation_....� _ ...Distance to nearest lot line---- <br /> Number of pits--------/-__.-- --Lining material . _ __Size: Diameter---=;FJ `..___Depth_q2-S f ____ 1I <br /> Cesspool: Distance from nearest well_-_-__.-----__-_Distance from foundation---------------.___.Lining material_-_-_-__-_._--_.____--_--_--.--. <br /> F Size: Diameter----- --------------------------- ---Depth-.--------------------------------------- f-----Liquid Capacity --.gals. <br /> f Privy: Distance,from nearest well--------_---- ----------_------------------------Distance from 'nearest building._---_--___-___._________-____-____._. 1 <br /> 0 <br /> ��rr ❑ Distance to nearest- lot line--------------------------------- -----------------------------------------•--------------------------------------------..------------ <br /> Remodeling <br /> .- -------Remodeling and/or repairing (describe):--,-.--------------r---------------------------------------------------------------------------------------------------------------------'---------- <br /> ---------------­------------------------ •--•-----------_---------- <br /> = T;-- <br /> # --------••----- --------------------------------- ----- -------•.. -------------------•--------------- --------- ------------------------- -------------- <br /> C a----------------------------------------------- <br /> .d <br /> ;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., 69rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----------- --- - ------------ .- ----- -- - ---- _. /or Contractor) I <br />.. F .�. • - ` ... <br /> r, Tale- ;x <br /> I(Plot plan, showing size of lot, location of system in re ion to wells, buildings, etc., can be placed on reverse side). <br /> , <br /> .FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY +v� �='k' "-?�2�` DATE �1`7�- G ` <br /> REVIEWED BY-------=----------------------- ------------------------- DATE-------- ` r <br /> BUILDING PERMIT ISSUED------------------ ---------------------------- --------------=------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----------------- - - -- -------------------------------------------------------------------------------------- ------------- <br /> --------------------- ---------I------------I--------------------I-------- <br /> -----------------------------------------------------__-------------._--_--I-------- __._.__-_.-------.--...---_______-_---___-_-_--__---_--_.-.-_-._-_--..__--._-.--_-__---_-.--._---_._-____--__-___---.-____---______---__-.._.-- <br /> I <br /> S <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> 14 <br /> FINAL INSPECTION BY:---, _ ?%: -t, _----__.__-__ Date_.-- � _. C-_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California i- Manteca,California {• Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.120. ' f <br />