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FOROFFICE USE: <br /> 31of v' <br /> E.�-(�_t-------a_ -_(,_� APPLICATION 1=0R SANITATION PERMIT Permit No. .. ..................... <br /> ----- ---I--------------------------------------- {Complete in Duplicate) .a <br /> ` --------------------- This Permit Expires 1 Year From Date Issued 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 LOCATION (N_ � /7P' <br /> U . <br /> Owner's Name.------ ....... --•------•-----_-- <br /> -------------------------------- ------{----------------•-------------. Phone------............................... <br /> Address----------/-��_ _,'S- �J-1?''r ---------------•--------------------- y <br /> Con#rector's Name. 112-r---- --------------------------- -------------------------------------------------------- Phone--- <br /> Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __j_- Number of bedrooms._.__ Number of baths Lot size <br /> Water Supply: Public,system ❑ Community system �rivate ❑ Depth to Water-Table <br /> _ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0'*__Hardpan ❑ <br /> Previous Application Made: {If yes,date___________________) No New Construction: Yes 2--No ❑ FHA/VA: Yes P}— No ❑ <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 well--------- -----[ Distances from fouunnd�afion--- __.___.Material--- <br /> No. of comartments___ �__�.�`«�--------:. <br /> p Xr-.---•---------Size..JX-"_._,Ii(A . <br /> Liquid depth---- - Ca acity...���--------� __ . <br /> y � <br /> Disposal Field: Distance from nearest well._..'^,_.=Distance from -foundation----Ii9-------Distance to nearest lot line_-X�___... <br /> - <br /> Number of fines------�-- --- - Length of'each line------, --------Width of trench---.'t"---•------------------ <br /> _046-4-Depth of filter material----AF!! ,% <br /> �____-_.Total length ______________ <br /> Type of filter material <br /> Seepage Pit: Distance to nearest w'611----------- Distance from�f/oundation__/�.......Distance to nearest lot line.._!___.__... <br /> Number of pits_-__ _-_..------Lining material_ P,401 r____Size: Diameter---1,2,3___.___- De th___ � fi¢•�i <br /> Cesspool: Distance from nearest well:_–: :______°Distance from foundation---------------_._~Lining mate al_-__________________________.__,.. 1 <br /> 01 Size: Diamefer-------- ----- ------ ----------„--._Depth---•------------------------------ -----------------Liquid Capacity---------=-----------------gals. <br /> Privy: Distance from nearest.well.__-------------r________.__--.-------__---_;__Distance from nearest building--------------------------- <br /> Distanceto nearesf'lot line----------------- - -----------------=--•-----------------------------------•---------------•------------ --•--------�------------ <br /> Remodeling and/or repairing (describe-------------------- <br /> -lst'iG�_40(11/__..S_'ORJ i y�C'' ------- <br /> - -------------------------------- ---------•------------•-----------•---------••---•-----------------•--------•---------------------------•--------------•------------••-------•------------------------------ --------- <br /> I hereby certify that I have pre pared'this-applicatiorf and-that the`work will'be done-in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the.aSan Joaquin Local Health District. <br /> • <br /> F r , <br /> (Signed)----------------- ' ( !” <br /> ----- ------ ' ----------------------------------------------------- <br /> - ( } ( e or Contractor) <br /> - <br /> Plot tan, showing size of lot, ocation of s stem in elation to wells, buildin s, etc., can bele I � �� <br /> ( P 9 I Y 9 placed on reverse side). <br /> FOR DEPARTMENT USE NLY <br /> APPLICATION ACCEPTED 13Y-- -----�1�--'--��'� _'l•�-------------•---=-------••---------- DATE_..�=.��_":C ------•---•----- - --------- <br /> REVIEWEDBY---'----------------------------------------------- - ---------------------------------------•----------•-_-------- DATE..-•----------- <br /> BUILDINGPERMIT ISSUED______________------------------------------------------••-----------------------•----•-----------------------------­ DATE------------------------------------------ ---=-------------- <br /> Alterations and/or•�ecommendations:----------------------= -------------- <br /> --------------- <br /> -------------------------------- <br /> ------------ <br /> --'---- •-•--r-------------•a'------- <br /> --------------------------------- <br /> --J <br /> ~� ._- /_- --- - - -� L ----------------- • ----- -- <br /> ------------`---- ........ ------------...._ ---------------------------------------------------------------- ----------------- --------------- <br /> FINAL INSPECTION $Y Date ........... <br /> 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 REVIeEO 8-59 r.P.=2M 6-60 <br />