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FOR OFFICE USE: <br /> ------------------------- -------------- ---------------- <br /> E ------- -----------------------------I------------------- APPLICATION FOR SANITATION PERMIT Permit-No. 2&0_7.3 <br /> ----------------- ------------------------------------ Compiete in,,'Duo icafe) <br /> o h <br /> ---- ---- ------- --- ----------- ---- 7_�fr____M_.1_,T-his_Permit Expires 1 Date issued --- <br /> Applica <br /> Application is hereby made Year From Date Issued 0 17�!03o <br /> to the San Joaquin Local Health <br /> District for a Permit to construct and install the work hereiXI.Ossribed.. <br /> This application is made in cornpliaiiqe <br /> 1._­ — - - - with County Ordinance No. 549. <br /> i4 <br /> AND I Ns ' <br /> O� ADDRESS AND OCATIO � '_F� <br /> /- 4`L _.1 ------------------------ ----------- ......... - ----- -- <br /> Owner's Naruf-"- -- ----- --- <br /> ------------ -- Phorie--! <br /> ----------- <br /> ---------------------Address-------..(a -- --------- _k 70 <br /> Contractor's Name--------- <br /> ----------------------------------------------------- Phone-------------------------- <br /> Installation will serve: Re-sidence Apartment House E] Commercial E] Trailer Court Cj Motel 0 Other 0 <br /> Number of living units: _'Number of bedrooms A.- Number baths __/__ Lot size ------------------------ <br /> ---------------------------------- <br /> Wafer Supply: Public system Community system [:] Private Deptyh "o Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] <br /> Sandy L8am in Clay Loam E] Clay El Adobe[] Hardpan ljo <br /> Previous Application Made: [If y4s,,dote---------------------)1 No-0—NeW_Consfruction: Yes 0 No El PHA/VA.- Yes F No <br /> - <br /> TYPE OF INSTALLATION AND'SPECIFICATIONS- <br /> (No septic tank or cesspool permitted if public sewer is ava'ilaxble within 200 feet.) <br /> Septic Tank: Distance from nearest well_____:.__.__----Distance from foundation--------------------Material--------- <br /> --------------------- ----- ----- <br /> El No. of compartments- ---Size--------------------------------Liquid depth-------------------------:Capacity-----------•--------- <br /> Disp,,�Field: Distance from nearest well.... ........Distance from foundation- _j� <br /> ­-Ze.________.Distance to nearest lot line___ - I------- <br /> Number of lines---------/Z------------ --------Length of each line----7_�K !> <br /> ---Width of <br /> Type of filter material_ .__ Depth of filter material------4F ------Total length-_____ ---------------j----- <br /> ------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation'---.,-------------- Distance to nearest lot line__.___- <br /> 0 Number of Pits------------6_------Lining material---------------------- Size; Diameter-----------------------Depth------------------------ <br /> Cesspool: Distance from nearest well______.__._--- -Distance from foundation---------------------Lining material---_ ------------- <br /> 0 Size: Diameter-----------------6•--- ---------------Depth----------------------------- --- ------------------Liquid Capacity t----------- <br /> #--- ------- <br /> -------------- <br /> Privy: Distance from nearest well------ -- ----------------------- ----------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line-------------------------------'------------------- <br /> Remodeling and/or repairing (describe)-- ---- ------------------------------------------------------------------------------------ <br /> ---------------I---------------- <br /> ----------------------------------------------I--------------------I----------------------------------------------------------------------------------------------------------------------------i----------------- ---- <br /> --------------------------------------------------------------------------------------------------------—------------------------------------------------------------------------------------------------------- <br /> -------------------------------------- ------------------------- ----------- ---------------------------- ------------------------------------------------------------------------------------------------------- ---- <br /> I hereby certify that I have prepared this appjicaf ion and that the work will be done in accordance with San Joaquin County <br /> ordinances. ��e lbws, and rules hd r ulation ' the San Joaquin Local Health District. <br /> (Signed) -----1--- -- --- ------- --- -- ------- --------------------------------------------------_;-----------------------(@�ne� d/or C <br /> ontracforl <br /> By:------------ ------- - -------------------------------------(Title)----------------------------------- ........ ------------ <br /> (Plot plan, showing size of lot, location of sys <br /> in relate n to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> Y <br /> APPLICATION ACCEPTED BY-.,4,Z,,- ------------- ---------------------------------------------------- DATE----7-J-_I�3 j <br /> REVIEWEDBY-------------- -------------------I---------- ------7----------------------- ­-------------- --------------------------- DATE------------- --------- k <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------- DATE.---- -------- <br /> Alterations and/or-recommendaf ions:---------- --- --------- ( <br /> --------------------------------------------------------------------------------------------------------------------------11--------------------------------------------------------- ------- ------------_ --------- <br /> ---------------------I---------------------------------------------------------------------------------------------------------I <br /> ---------------------------------------------------- ---------------------------------------. ..... ----------------------------------------------------------- ------------------------------------------------------- -------------------------------------------------------- <br /> ------------------------ -- ---------I—---------------------------------- --------------- - - <br /> ----------------------------------------------------------------------------- - ----e---------------------- <br /> ................ <br /> --- -- -- <br /> FINAL INSPECTION BY:-.- <br /> - --- <br /> SAN JOAQUIN LOCAL HEALTH,DISTRIdt-) <br /> 1601 E.Hazellon Ave, 300 West,Oak,Street'�13, <br /> 5"" ' 124.SYcamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,­Ca1jf0_r.&1 Tracy,California <br /> ES 9 REVISED B-59 2M 3`63 F.-.Ca. <br />