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R OFFICE USE: <br /> APPLICATION-- FOR SANITATION PERMIT Permit No. <br /> -- --------------------------------- --------- <br /> --------------------------------------------------------- (Complete in Duplicate) Date Issued --- <br /> ------------------------- -------------------4---- ---- I This 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 AND LOCAT19N__47at-cio/re ef,�o Or <br /> Owner's Name--4ervew."i--o-A _ 1W------------------r------------------------ ------------------- Phone.----- ------- ----------- <br /> Address-----4-/ <br /> hone---------------------------Address__-4-/----_/------ ------ ------------------------ <br /> Contractor's Name-- 72-A e!7 ------------------- --------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence P—t Apartment House E] Commercial_E] Trailer Court Ej Motel 0 Other ❑ <br /> Number of livin� units: --/-- Number of bedroom's ---�_ Number of baths __/--- Lot size --o-Aa'-OW- V- -----I----­------------- <br /> Water Supply: Public system-E] Community system Priva to 5gltepth to Water Table __V_ (t. <br /> Character of soil to a depth of 3 feet: San.d.-[:] Gravel 0 Sandy Loam E] ' Clay Loam E] Clay 0 Adobe [:] Hardpan 0 <br /> Previous Application Made: (If yes,date.-.---_----:---..--- No 93-` New Construction: Yes E] No Ar—FHA/VA: Yes D No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS' <br /> (No septic tank or cesspool permitted if public se.wer is available within 200 feet.) <br /> Septic Tank:., Distance from nearest well-----------------Distance from foundation--------------------Material---------------_------------------------------ <br /> No', of compartments---------------------------Size------------------- ------Liquid depth-------------------------Capacity---------- ------------ <br /> DisposaL-Field.: Distance from nearest weli_Jfzr Distance from foundation-Al?-----------.Distance to nearest lot line-.---------_ <br /> Number of lin ----- --Length of each line----- .0. .........Width Of trench.1V.........----------------. V% <br /> Type of---filter mate' -------- <br /> es <br /> 0a--Depth of filter mate Total length----�Vp---------------------:--------- <br /> IX-1 J* e.,orr. *f <br /> Seepage Pit: Distance to nearest well---/01,19------Distance frQm f0tinclation-----;rtW.......Distance to nearest lot li <br /> U§o— Number of pits_ ------------Lining maferiaI.__,A%?`6".Size: Diameter , -------Depth_Af____]t&4 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------.__Lining material_:.:..eria --------------------- <br /> El Size. Diameter.----------- --------------- ------.Depth------------------------------------ - -------------Liquid Capacify----------------------------gals. <br /> Privy: Distance from nearest well--- from nearest building-...-...--.-----.-.-----.------.....----- ,V <br /> ❑ Distance to nearest lot line-------------- - --- ------------------ <br /> ------------------ ----------r-------------- <br /> v <br /> Remodeling and/or repairing (describe):-- -------- 0­ <br /> ----------------I-------------------------------------------------------- <br /> I <br /> -------------------------------------------------------------------------------------- ------------------------------------------------------ ------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> f----------------- ------------ --------------------------------------I-------------------------------------------------------------------------------------------------- ------------------------------ --------------- <br /> I hereby certify that I have F;repared 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 /> -------- ---- -------- ---- ---------- --------------------------(10��r Contractor) <br /> (Signed)--------------- <br /> 1 A ------------(Title.------ - A�V_111Z,4-t------- - - -----_------------ <br /> - By:----------------------------------------------------------------------------- - ---- <br /> i <br /> (Plot plan, showing size of lot, location of sys+em in rel�afj o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------1-5 0! -------------------------------- ---------------------------------------- DATE_.._4�= —----------------- <br /> REVIEWEDBY------------------------------------------------- ------- ---------- ------------- ------------------------------------------ DATE <br /> BUILDING .PERMIT ISSUED------------•_ ------------------------------------------------------------------------------------- DA-TE--------- ------------------------------- <br /> Alterations <br /> ATE------------------------------------------Alterations and/or;7 --mend tions: ---- - ----- ;.�-------------- ----- ---------------------------------------------------------- --- - ---------------- <br /> ------------------- ----- --- <br /> ------------------------------------------------------------------------------------ <br /> -- ---- --- ----- <br /> ------- ------- <br /> --------------------------------------- ---------:---------------------------------------- <br /> _J01 - e, - --------------------------------- <br /> ------------------------------------ --------------------------------------------------------------------------------------------------------------- --- --------------------------------------------------------------------- <br /> -------------- ------- --------------------- -------------- - - - ----------------------------- -------------------------------------- -------------------- - --- ----------------------- <br /> I- - <br /> FINAL INSPECTION BY:------- -- - ---- ------- -------------------- Date.......... - -- ------------ -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601'E._Hcix*llonAv*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> n Lad!,California Manteca,California <br /> Stockton,California Tracy,California <br /> F.P.Ca. <br />