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FOR OFFICE USE: <br /> ----------- <br /> it <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ..Y.q <br /> .................. <br /> ----------- ------------ -------------------------------- <br /> - -------------------------------------- ----------11----- (Complete in.Duplicate). <br /> Date Issued _/j2--- <br /> - --------------- -------------------- - - -------- This Permit Expires 1 Year From' Date Issued <br /> Application <br /> tion is hereby niade'�to the San Joaquin Local Health District for 'a permit t cons ruct and install the work herein described. <br /> This 4 /�T . Z 0(./— /"- — <br /> Th- 7plication is with County Ordinance No. 549. - - , " _F <br /> JOBADDRESS AND LOCATION --- -- -------- - - --------------- --------- --- -- ---------Owner's Name-- '°--- ------ ------------------ -- - ---------- — --------------- Phone------------------------------------ <br /> Address-------_---------- --------- ------ -------------------------------- <br /> - ---- --- --- ------ - -------- ------ ---- -------r----------- <br /> ------ ---- <br /> A' <br /> 2 Contractor's Name-------- ........e_ ..... -- - - -- ----------------------------------- ------- Phone----------------------------------- <br /> Installation will serve: Res dente Apartment House E] 'Commercial E] Trailer Court E] Motel El Other ❑ <br /> - <br /> Number of living units: --- Number of bedrooms ___-Number qj.baths'_ Lot size ----- ----------- <br /> Water Supply: Priv <br /> Community system m st <br /> PubliclsyeEl El & Depth <br /> t Xater Table -------- ft. <br /> , <br /> Character of soil to a P ! o <br /> f j a W 'depth f 3 feet: Sand (] Gravel E] Sandy Loam Clay Loam L] Clay E] Adobe[] Hardpan F] <br /> M � .4 <br /> Previous Application Made- (If yes,date---- --------------- No E] New Construction. Yes ❑ No E] FHA/VA: Yes ❑ I�IoIE] <br /> 4 4 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or c6' sspool permitted if public ewer is available.within 200 feet.) �6- <br /> Septic ank: Distance from nearest well____c5'0_1_'Distanef ---- <br /> jounclation----- ------Matyrial --- ----------- ----------- <br /> Liquid clepfh__,�/—--------- --------Capacity___ <br /> No. of'compartments---- -- ------ ----- ft i <br /> Size <br /> Dispos Field; Disfanc6 from nearest well.4��Z__'4_Disfance from foundation------�-----------Distance to nearest lot line-c;'_'.`_I_____ <br /> I <br /> ni <br /> �$ ---/ - ------I---------- <br /> Numbe of lines_._-----------C;q ---------------Width of trench_... <br /> r. --------Length of each line-------4 tc -- Or <br /> Type oI filter material- ---------Depth of filter materlal------/I---------Total length------ <br /> f <br /> Seepage Pit: Distance to nearest well_.-____-___-_--.---"Distance from foundation--------------------Distance to nearest lot line---------.-.__..- <br /> : <br /> El Number of pits------- --------------Lining rn aferial-----------------------Size: Diameter----.-------------.-._.Depth- --------------------------- <br /> 5f well_____________ ___Distance...... foundation_________..__.____..Lining material------------------- <br /> Distanc --------------- <br /> Cesspool: e from neare ---Distance from foundation <br /> Size: IJ'i'a' meter--------------------------------------Depth--------------------------r--------------------------Liquid Capacity-----------------------------gals. <br /> q <br /> Privy: Distance fr'om nearest well----------------------------------------------.-Distance from nearest building-.--..--_.-..---_-.__-_----------..____._. ' <br /> �] Distance <br /> uilding---------_--------------------------- <br /> Distanceto nearest lot line---------------=----------- ------------------------------------------- --------------------------------------------------------------------- <br /> I . .. �.. (describe):-__ zL_ 'd <br /> Remodel in�LaTid/a. -- ------ ---- ------------- - -- -----46----- ------ !fn---- ------------ <br /> ---------- -------------- --------------- 7-------------------------------- --------------------------------------------------------------------- --------------------- <br /> ---------- - - --------- <br /> ----------�0_ 611-------- -------------------------------------------------------------------------------------------------------------*------------------ <br /> ---------------------------------------------------------------------r----------------- ------------------------------- <br /> ------------------------ ---------I---------h-------------------------------------------- <br /> -I --- <br /> I hereby certify that 11 ave prepared this application and that the work will be done in accordance with San-Joaquin County <br /> ordinances, State ws and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---------- ......... .....- --- ---- --- <br /> I------------------------------------------------------------------------- :��nd`/or Contractor) <br /> --------- --- ----(Title)----------- F ------- <br /> By:-------- III --- - ---- ----r- ------w--------------------------------- -------- -------------r---- ......... <br /> (Plot plan, showing size of lot, location`of*sysf�ein rela n to wells, buildings, etc., can be placed on reverse side).'--- <br /> T FOR DEPARTMENT-USE ONLT___ <br /> 2f-Xl- <br /> APPLICATION ACCEPTED <br /> ! BY -- --- - -. I ­ <br /> -------- DATE-------- <br /> -- - 6ATE-----1- <br /> -f---------------- - -------------------- <br /> REVIEWED <br /> -------------------REVIEWED BY------ - *$ - <br /> --------- ----- ------------- -----------e----------------------------- -- DATE------------------------------------------------------------------------------------------------- <br /> ------------- <br /> BUILDING PERMIT ISSUED <br /> ------------------------------------------------- -1--- ------------------------- <br /> ;DATE --------- <br /> Alterationsand/or recommtndations:---------------------------------------------- -----t------I----------------------------------- ---------------------------------------------------- ------ <br /> I�I <br /> --------------------------------------- --------- <br /> -------------------------- ------- ----------------------------------------- - <br /> ------------­­........ ---------- <br /> -------------------------------------------------•----------------------- ------------------- --------------- I------- ------------------------- -•--------------------•------------------------------------- -------- <br /> --------------------------- ------------------------------ ----------------------------------------I------I-------------------------------------------------------------------------- - --------------------- <br /> ----------------------------- ---- --------- ---------- -------------------------- ------- ------------ J_!_-- -------------__------------------------------------------------------------------------ <br /> /V <br /> or FINAL INSPECTION BY,: Date-------------------- ......------ ----------------------------- ------------- <br /> ---- --------- <br /> ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton A,4 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California. Lodi,California Manteca,California Tracy;California <br /> VS 9 REVISED 0-59 3M 3-'63 F.P.C93. <br />