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FOR OFFICE USE: II <br /> -.-_..!M_.. APPLICATION FOR SANITATION PERMIT Permit No. -......-.....-..-..`� <br /> ............-------- -----M <br /> (Complete•in Duplicate) <br /> Issue <br /> .�.. .�' <br /> ---_------------------- ------------ ___.__..--._°.-. This permit Expires 1 Year From Date IssuedDate d_ <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 wito nay Ordinance No. 549. <br /> �i / , J <br /> I JOB ADDRESS AND LOCATION_� <br /> Owner's Name.14C71k--- ....... ` /T----------------- --- -------------------------- Phone....---------------i--h----------- <br /> Address..,1,/..6-19--.�------I� e— --� -- - �+5°-- 42_A_.4(----------------------- -------- ------•-------- -•------ u- ------. <br /> Contractors Name-------------I--------------------------..-..-. .---------------------------------- --- <br /> - Phone. :. - . <br /> ❑ ❑ <br /> installation will serve:- Residence ❑ Apartment House ❑ Commercial ❑ Trailer �' Mo+ef Other <br /> Number of livingunits: . ._ Number of bedrooms Number of baths—1 II, --,: �---- Lot size .... - .... <br /> Water <br /> - - ----=------------ <br /> Water Supply: Public syste m ❑ Community system ❑ Private " Depth to Wafer Table �'). ft ---' �`' <br /> Character of soil to a depth of 3 feet- Sand [} Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe Hardpan ❑ <br /> l11 -1 <br /> Previous Application Made: I(If yes date_-__---.- J No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No <br /> i TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> f o septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> Septi Tank: Distance Ifrom nearest well _---Distant from foundation..40........Material ._ _...-.G ��7— µ <br /> No, of compartments..____- .....:.......Size-- __x. x .......Liquid de th__ .. .s__. __...__ Capacity------?_4©.Q_a <br /> Dispo I Field: Distance,l'rom nearest well f"Distance from found i n._ �+ <br /> . . -. Distance to nearest lot <br /> ��f lines.._.__--._... Length of each line� �.....d. _ Width of trent . .-_2. -/nC-._� <br /> Type of filter material <br /> ._._ _, . G Depth of filter material----�_ "//J[---Tota_I length- = '4d--------_--------- <br /> Num er p <br /> 1. <br /> Seepage Pit: Distance. o nearest.well-.....................Distance from foundation.. . <br /> Distance to nearest lot line---- <br /> ------------- \ <br /> Number of <br /> Cess❑ool: Distance �f,•omsn�rest well -Lining mDistanlce from Size: Diameter--------......_-...___Depth.__------.-.---..__...-__.-...... � <br /> p foundation-..-._-_.......... ..Lining material------__.___....._.___--...._ - <br /> ❑ Size: D+ameter- .-- ------. -------.Depth------- ---------- --------------- <br /> i�. Liquid Capacity -------------- gals. r <br /> Privy: Distance from nearest well±.............................. ... .. ..........Distance from nearest building �t] <br /> f g - <br /> ❑ Distance to nearest lot �ine(:. . ...__- __----- . .._ <br /> --------- -------- <br /> Remodeling and/orrorepairing (describe)----- -- --------------\---- -- ----------- " <br /> E <br /> e.-NI <br /> ------------------------------------------ <br /> -------- -------------=`----- <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 nd regulations of the San Joaquin Local Health Distri t. <br /> (Signed( ... y-- �,� ---.(Owner and/or Contractor <br /> - ..._. <br /> sY ------•----------------li--------- --------------------------- --- ------------------------------------ ...(Title)---------------- --------..---- - ---- -------------- <br /> IV(Plot plan, sh�wing size of lot, location-ff system"in l�latl to wells, buildings, etc., can be placed on reverse side). F <br /> { il i- yN'1<OR4DOARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED BIY._.. f <br /> �l'U - DATE -�„3-"` ---- ----- --- <br /> REVIEWEDBY--_.-------------- -- p- --- ------ --"- - ._-- - - ........... - --------------- - -----------------------------"----- DATE <br /> BUILDING PERMIT ISSUED...__ - % DATE---------_------------- <br /> _ <br /> Alterations and/or recomme4ati4s:. -_t--.-- r:4------..-.-_- <br /> ------------ --------- ------------ ------._ a -_ _ <br /> �_ll--Tzxam. -------- - �" <br /> ------------------------- --- -------------- ------ . -- --------- ------------- <br /> f v ` `,t <br /> M r 4 + <br /> -......-�. ... ------------------------------------�.- -.__ -....-..........-.-------------...-_-__----'------------- -----_..---.__-.------._-------------- .... -..._..-...._.-..-......... <br /> � t <br /> FINAL INS ECTION BY: i� 4 �C�1'f Date-- ---- -.—'� <br /> = SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave, a 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California ✓I <br /> E.H.9 2M 1.67 Vanguard Press Tray,California <br /> Y <br />