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FO R QFFICE USE: <br /> � --- <br /> ____________�---. APPLICATIb *FOR SANITATION PERMIT Permit No. _-_l !,- <br /> - <br /> 1113�--- (Complete,in Duplicate) /!/ <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 O ante 549. F , <br /> JOS ADDRESS AND LO ATIO 1 / - == )_------- <br /> ------------------------- <br /> t- <br /> Owner's Name_-'_-------- �! -_-_ - --------------------------------- <br /> Address <br /> .}--------- <br /> ... <br /> -1�_ <br /> ,f --------- -------------------------------- --------------- - ------ Ph <br /> Address !!�!__D u• ,- -- -------------------------------•--•-----------------------•--- -- ------ <br /> Phone <br /> Contractor's Name •--� - - - Phone.... <br /> ---•---...- <br /> Installation will serve: Residence `Apartment House ❑Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ q" <br /> Number of living units: Number of bedrooms . ._ Number of baths -I--- Lot.size _ t �-�R'-1 _r---_-- <br /> ------------------------ <br /> Water' Supply: Public system ❑ Community system.�rivate ❑ Depth to Water Table _APt. <br /> Character of soil to a depth of 3rfeet: , Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&�Harjpan ❑. k <br /> Previous Application Made: (If yes,date----------- -----) No � New Construction: Yes E?'-No [I FHA/VA: Yes Qom'N6-EJ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ,~ :'- <br /> (No septic tank or cesspool permitted if.public sewer is available within 200 feet.} <br /> Septic T nk: Distance from nearest well-- <br /> p -------------Distance from foundation---/, --_ .------ <br /> No. of compartments----- ---------------Size ----- -._--Liquid depth----- -----------Capacity_ - <br /> ---- <br /> Disposal Field: Distance from nearest well--- Distance from fou ti$n, -A-1--"....Distance to nearest lot line-.----­------- <br /> e__ <br /> �---- <br /> [�I Number of lines-------�--- ------------ Length of eat'lin M9_11 a l�lidth of trench_,7.------:----------------- <br /> Type of filter material__/ Depth of.filter material-- — <br /> t - -.Total <br /> �. <br /> Seepage Pit: Distance to nearest well-----__ '__=- ._____Distance fro four ation----- �.._-•-Distan a to nearest lot line-_ _----.-- <br /> �.Number of pits....-_.Z---.-------Lining material-_-- _-- _ -- Size: Diameter-- -____ Depth_.2-s --___________________ 6 <br /> Cess ool: Distance from nearest well----.------- Distance from foundation------------------foundation . Lining material------._---_---------------- <br /> p <br /> ❑ Size: Diameter-_. ------------------ --------=Depth-------------------------------------------- ------- 0 <br /> Liquid Capacity gals. 3 <br /> Privy: Diata6ce from nearest well------------------------------_- -------__Distance from nearest building----------------------------------------- <br /> ,/����� A <br /> F1 Distance to nearest lot line - r <br /> p / ------------------------------•----------------------_ 1 <br /> Remodeling and/or repairing (describe):-------- ----- <br /> - -------------------------------------------------- <br /> --------------------------- -----------------------I-------------------------------•-----------------------•-------------------•------:--------------------------------------------------------------.------------- -------- <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 la.Yrs, a d rules and regulations of the San Joaquin Local Health District. <br /> �_ <br /> (Signed)...........-- ---- -- ----- - -----_- r Contractor} <br /> - -------------------- "`I' <br /> By-------------------------------------------------------------------------- -- ------------����'� 1 -,--(Title) �i -�' <br /> (Plot plan, showing size of lot, location of system i ation to wells,.buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 'APPLICATION ACCEPTED BY... ... <br /> - DATE_ y.�, <br /> REVIEWEDBY --------------------- -------=------------ ----------------------------------------------- DATE---------- .t <br /> F BUILDING PERMIT �s�6 ED _ °DATE--------------- <br /> - ------ ------ <br /> Alterations and/or recommendations:-_------- . __• r _-- '� -1d -c--- _ rc-c� � <br /> -- <br /> --------- Z� <br /> -------------------------------- - <br /> a <br /> --------- '------------------------------------------------- <br /> -- <br /> F1NAL INSPECTION BY: --- ----- ---- -------------------- ----- Date-- V--------------------------------------------J <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California i <br /> ES 9 REVIBEO 8-59 31A 3-'63 F.F.00. j <br />