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'FOR OFFICE I LIZE �� <br /> x " :73----------- <br /> ----------------- ---- <br /> --------- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. .......................... <br /> ------------ ---- ----------------------- -- (Complete in Duplicate) 3 u 3 <br /> ---------------------------------------- This Permit Expires 1 Year From Dater 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 withCountyOrdinance Pa. 549. <br /> JOB ADDRESS AND L CATI N.- f lf�------- _a,:72..e�-------------------------------------------------.--_-----_------------------- <br /> L <br /> Owner's Name............ ` Imo. . ....... _/._ .e:---------------------------------------------------------------------------- Phone.............................. <br /> Address......................... r -� ----------------------------------------------•---------------•--•-•------ <br /> f� <br /> Contractor's Name----- 712-- _ ........................................................ Phone......................... <br /> Installation will serve: Residence r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livin units: ...1 Number of bedrooms -3--- Number of aths ___fir Lot size ---- __ . ._--.-_ <br /> E Water Supply: Public system ❑ Community system [I Private Depth to Wafter Table .0. ft. <br /> ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> i v [RI" <br /> Previous Application Made: (if yes,date--------------------) No �ew Construction: Yes LR" No ❑ FHA/VA: Yes ET'�—No ❑ <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I Septic Tarek: Distance from nearest well-_t _-------Distance from foundation._./-a.I....-.Material..... <br /> mW- 29 <br /> ,..... .Z. ..X._-_-. <br /> Size_:_ r <br /> No. of eoartments____ __....._ -. ;a� .�rY _�Li uid de th__._. _...�._..._ Ca aci A!�!p...... <br /> Disposal Field: Distance from nearest well__, ___2 Distance from-founda#ion____ <br /> Distance to nearest lot line.... ___ <br /> Number of lines------+°;,.'i..:T�____.___._._Length of -line----1j,37* ILC.'___.Width of trench------Y,!.................. <br /> Type of filter material-_t ez__X P'V Depth of filter material...4-tl-------------Total length--- ____-------__--_---_---.____ <br /> f . - 1 <br /> Seepage Pit: Distance to nearest well___--..-_------Distance from foundation__-- _Q._.......Distance to nearest lot line----------------- <br /> Nu <br /> ----------.---_•Nuor of pits...'.'..-.----------Lining ------Size: Diameter---,l._�'`---------Depth---f--------•--------------- <br /> Cesspool: Denttante from nearest well-----------------Distance from-foundation----------- ._:.. Lining <br /> - <br /> material-_--------_--_.----.--•---_------ <br /> -__- <br /> ❑ Size: Diameter--------------------`:._ Depth.�•-------._ ---------------...--------•----•--••-Liquid Capacity............................gals. <br /> Privy: Distance from nearest well------------------------------------------- ----- <br /> \ <br /> Distance from nearest building..........................._.------------ <br /> ❑ Distance to nearest lot line----------•----------- -•------------- -- ----•-•-- ------------------------------------------.-------­-­------------------- <br /> ' Remodeling and/or repairing {descriL�e}:-'�---=,_--'=--=-�'-'�/t-=��------------ - ----------------------------------------­---- -- ---- -- - ---••---...----••- <br /> ---------------------------------------- -•-------=- <br /> ------------.:........... <br /> hereby certify that 1 have prepared this application and that the work will be.done in accordance with San Joaquin County <br /> ordinance to la d rules and ��Ilarfions of the San Joaquin Local Health Dis#riot. <br /> 5i ned - - '..-••. -------------- --------------------------------- <br /> 4 (Owner and/or Contractor) <br /> - - <br /> [Plot plan, showing sire of ot, Iota#ion of system in on +o wells, buildings; etc., can bs placed on reverse side). <br /> FOR DEPARTMENT USE ONLY �- <br /> . � :. _ � <br /> APPLICATION ACCEPTED BY- �i ----- ----------- DATE---3---�0_---{03-------------------- <br /> REVIEWEDBY------------------- ---------•-----------------------------------•- <br /> ---------------------------------------------------------- -DATE-------------------------------- <br /> BUILDING PERMIT ISSUED-----.---- ---- -- DATE-------- -- <br /> Alterations and/or recommendations:__. ... _ =_ ?� <br /> . ......-- ---------- <br /> --•-•-------------------------------•----------------... ---------- ---------- ------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------- •--------------- -------------------------------------------------------- <br /> ------------------------------------------- ------------------------------------------------------------------ ------------------------------------- -------------------•--------------------------------------------- <br /> FINAL INSPECTION BY:-- - -- --------= Data <br /> e SAN JOAQUIN LOCAL HEALTH DISTRICT' <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> IS 11 REVISED 8-59 t!M 5-61 ATLAS <br />