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FOR OFFICE USE: <br /> ........... ------ -- ------------------------- ---- <br /> --------------------------------------- ------ ---- APPLICATION FOR SANITATION PERMIT Permit No. 2.fZ611iZ_.7. <br /> ------------------z------------------ -------------il---- <br /> (Complete in Duplicate) <br /> ------------------ ---------I-- ------- ------------ This Permit Expires 1 Year From Date Issued Date Issued __/j=----- <br /> Application is hereby made'to the Sah toaquin Local Healf h Dist rict for a per�`if'f Z r;u?c —a and install t4Vnt*�+mrein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> C- <br /> AJ <br /> -JOB ADDRESS C)l I N <br /> Owner's Name ---------- <br /> te__1 ------ -­ ----- ---------------------------- ----- ---- ------ Phone------------------------------------ <br /> L <br /> Address-----------(Z-t-Aq. 4-V - <br /> -------- ---------_---------------------------------------L-------------------------------------- <br /> Zpp <br /> 4 <br /> Contractor's Name <br /> _n --- ------- --- --------------­---- Phone------------------- - <br /> Installation <br /> hone----------------------------------- <br /> Installation will serve: 'Resid.ence ❑ Apartment House E1-Commercial F] Trail4r Court [] Motel [] Other <br /> Number of living unit I Nurnber of bedrooms' `-%r-nber _batlii­�b__To` size. . ......�t3 1Z_ , <br /> ----------e---te, <br /> trr , —� — -*,/-------------------------- <br /> Watei� Supply; Public system ❑ Community system Private Depth to Water Table Ak_ ft. <br /> Character of 11 soil to a depf h 1Of 3 feet: Sand 0 Gravel E] Sandy Loam [?,/Clay Loam E] Clay E] Adobe C] Hardpa�n:o <br /> Previous Application Made: yes,date..- --- -:--------- No 0 New Construction: Yes El No El FHA' /VA: Yes E] Noo <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> .No septic tank,or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic/Tank: Distance' 'from nearest. . Distance.from foundation---i-Q--I--------Material_-___ ler-4--a"1111I <br /> compartments------ --- --- <br /> No. of -—-----------Size-3 ",X__tt�Liquid clepth----11---- Capacity-'W'.4_0 <br /> Dis f <br /> Field_ Distance from nearest well----.��.,_Disfance from foundation____J,*- --------Distance to nearest lot line- /---------- <br /> Jil <br /> Pe Length of each 1ine------6_0. ...............Width <br /> Number of lines----------- <br /> -Of french.----2—------ <br /> Type of Iter Depth of,filter material___-- __` __-..--,_-.---t__Total length--------- <br /> t <br /> .1. ----------------------------- <br /> Seepag D�sfancel o nearest well___-_.____-Pit., kpits----------------------Lining <br /> . -------Distance from foundation---------------_--Distance to nearest lot line__-____.____-_.__ <br /> ❑ <br /> ine----------------- <br /> 0 Number 'If pit -------------- --------Lining material----------------------- Size: Diameter-------------- ---.----.Depth------__----------------------- <br /> Cesspool: Distance from nearest well----------------I-Distance from foundation--------- ----------Lining material---------------------- <br /> --------------- <br /> ❑ <br /> Size: Diameter----------------------- ---------------Depth------ ------------------------ <br /> - --- -----------------Liquid Capacity------------------------:---gals <br /> Privy: w Distancelfrom nearest-well----------------- <br /> --------------------------------Distance from nearest building----------------------------- --------- <br /> DisfanceJonearest lot iine------------------------- ------------------------------------------------------------------- <br /> Remodeling 2aricl/oriWep:ajr.in9 (describe):-------------"------------------- - -- <br /> -------- -------- -- <br /> - ----------------- ----------------------------------------------------- <br /> ----------------------------------------------------------------�: ----------------------------------------------------------------- ---------------- <br /> ---- <br /> IF <br /> ------------------ -------•--------------...-.-------- -------------------------------------------------------------------- --------------------------------------------------------------------------------------- <br /> ------------------------------ --------------- ---------- - - f .. <br /> - ------------------------------------------------------1------------------------ <br /> e t �------;---------- -------------- ------ ------------------------------- <br /> I hereby, certify that I have pgrepared.Ais application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State/In S, and rules and­F&gulations of thelfSiin Joaquin Lo'cal Health District. <br /> V <br /> ---------------- <br /> ..... ..... ......... and/or Contractor) <br /> --- <br /> BY� <br /> r_ Q <br /> --------- -- - ------- <br /> (Title)------------------------------------------------ <br /> (Plot p1lari, showing size Of IOE'location-of,sysfem in rel ion to wells, buildirIgs, etc., can be placed on reverse side), <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- <br /> REVIEWED BY------------- 0 -------------- DATE-_-6Z--------9_7,d,'_�---------------- -- <br /> ---- ------- ----------------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT, ISSUED----=-------- -----------------------------:---•----------------------------------------------------- DATE <br /> ---------------- <br /> Alterations and/or recommendations-------------- --------------------- - <br /> --------------- ----------------- ­--------ill <br /> -- --------------------------:------- --------------------------------------------------------------------------- -------------------- - <br /> ------------------ <br /> ------------------------------------------------- <br /> ----- ---------- <br /> ----------- -------------- ------------l ------------------------- ----------------------------------------------------------------------------------------------------------------------------------- <br /> ----------- ------------------------------;-------------------------------------------------------------------------------------------- -------------------------------- <br /> ----- -- ------------ ----------------------- <br /> -- ------------------------ -- ------------ --------------- --------------------------------------------- ----------------------------- <br /> FINAL INSPECTION BY.- -------------------- <br /> ----------------------------------------- --------------------------- <br /> ---- ---2__, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CS 9 REVISED 8-59 3M 3-6:3 FA"XIC1. <br />