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OR OFFICE E: <br /> k,+` m <br /> �----------- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._.....�:-:.->..1.. <br /> ------ --- --------------------------------------- (Complete in Duplicate) _15 <br /> -------------- ------------------ This Permit Ex fres 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 /> JOB ADDRESS AND LOC TION 6 <br /> r� <br /> - --------- <br /> Owner's Name--- 1 �-! 0D?__4=---------------------------------------------------------------------- --- ---4---- Phone.................................... <br /> Address......--------•----- '` ------------ <br /> Contractor's Name------�(1, 1_.S , �, -----------------------------------•_-•-------------------------------------•----- Phone-----......... <br /> . Installation will serve: Residence [D' Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _____f Number of bedrooms __2__ Number of baths /--___ Lot size -_:� ---------------------------­-- <br /> Water <br /> _________Water Supply: Public system M, Community system ❑ Private ❑ Depth to Water Table ..6 ,ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0Hardpan ❑ <br /> f <br /> Previous Application Made: (If yes,date--------- I No ED' New Construction: Yes 0' No ❑ FHA/VA: Yes ❑ No G— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well_./I?.��,--------Distance from foun ation.a:...............Material__ ___---'!..��---___. <br /> (� No. of compartments------ ---------------Size--- yx---: .__Liquid depth---:--�-�-------------Capacity__if:�QZ <br /> Q <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- k <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----._.______,_________________ <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ <br /> r / ti <br /> See�p,a,g/e �It: Distance to nearest well_/Od____--_--__Distan rom un ation_ 0............Distance to nearest lot line____- ___,___-- <br /> Ll` Number of pits------t-------------Lining material_�7P.0 - _-.Size: Diameter__4/___'�-------------Depth-----------1�z-!�•_•- <br /> Cesspool: Distance from nearest well-----------------Distance-frorri foundation-------------- -----Lining material-_-.__._________________.___-.-.--... <br /> EJSize: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------- <br /> Privy: Distance from nearest well-----------------------------------------------._Distance from nearest building_ --__---_.______________---_._.-I..__._.. <br /> ❑ Distance to nearest lot line-------------------------------------------------------------•--•-----... <br /> Remodelingand/or repairing (describe):---------- ------------------------------------------------------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 regulatio s o the San Joaquin Local Health District. <br /> (Signed)--------------------------------------------------------------- - ---- - - ------ L--'-------------------------------------------•--•------- ---(Owner and/or Contractor <br /> By:------------------------------------------- ---- -- ----- ---------------- ----------------------------- •------- _(rifle)-------------------------------- ----- -- -------------- i <br /> (Plot plan, showing size of lot, latah s s em,in relati n to wells, buildings,-etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ----- - - - -- ------=----------------------------------------- 11--- DATE------=� �1 <br /> REVIEWED BY ----------- - ------------- DATE ------- <br /> BUILDING PERMITISSUED----------------------------------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations--------------------------------------• --------------­­---- •-----------------------------=----•-----...-----...-----•------••---•--------------------------- <br /> a <br /> FINAL INSPECTION BY:... ---- --- -------------- • ---- Date--------- <br /> 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,Ca"fornla Tracyr California <br /> E6-9 REVISED 9.59 F,P,CO3 2.6.60 <br />