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FOR OFF1 E SE: �- prmit'N0. .__--------------------- <br /> ---- <br /> APPLICATION FOR SANITATION PERMIT / <br /> _______________ _YS <br />- - in Duplicate) Date Issued ------- <br /> (Complete --• <br /> ---- -------------------------------- <br /> . 1 Year From Date Issued <br /> - This Permit Ex Tres <br /> here made to the San Joaquin Local Heal}h Distric 549 a permit to construct and install the work herein described. <br /> Application Is y <br /> This application is made in compliance with County Ordi ce o <br /> �y ------------------•----------------------------- <br /> JOB ADDRESS AND LOCATVON•--- = ---------- ------------------------Phone---=------------------------------- <br /> ---- ------ ------------ <br /> ----------- -------------------- <br /> 7 - <br /> Owner s Name-------- - - ------------------ <br /> �� _ _, ---------_------ -------------------- <br /> - ---------------------- Phone.. <br /> ----------- ----- <br /> '�------ ------ Motel Other ❑ <br /> Contractor's Name------ ------- Commercial ❑ Trailer Court ❑ ❑ <br /> artment House ❑ <br /> Installation will serve: Residence Ap 8'9 x]] <br /> ',�,---.Number of baths _- _-_-- of sae __. ----•------ -.- <br /> Number of living units: __.1--- Number of bedrooms Private ❑ Depth to Water Table __Ld ft. <br /> E Adobe 0--Hardpan ❑ <br /> Water Supply: Public system 5--community sysG av❑❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ <br /> I Character of sail to a depth of 3 feet: Sand ❑ FHA/VA: Yes ❑ No 1 <br /> hoil to Made: (If yes,date.__.__.__:------ -1 -No 53 New Construction: Yes UT ❑ <br /> Previous App , <br /> TYPE OF INSTALLATION AND SPEC.IFICATIONS:_ <br /> (No septic tank or cesspool permit#ed-if public sewer is available within 200 feet..) <br /> Distance from nearest well__:_`.---.----Distance from foundatiLnqud-=depth- atenal:-�=- -Capacity__F� -�-- <br /> I Septic T nk: --x-- y 9 <br /> No. of compartments_._:_----------- - -- Size--_----- ; <br /> i Distance from nearest well___`---------Distance from foundationn __E�-----__ ` .Width oftfrench s line- <br /> Disposal Field: -----Len Length of each line___ ;r <br /> I ❑/ Number of lines----------�-- g r O <br /> Type of filter..matenal_�_._/�----__----=Depth of filter materlal__��1.3'--------•-Total length____9d-•�-------•--•------------------ <br /> ' OL t <br /> Ir <br /> f See a -Pit: Distance to nearest well__-•`-�_-----------Dsstanc from foundatlon____._.�__.._.--..Distance to nearest lot line_________________ <br /> P � -Linin materlal__�__a�'.�-------.Size: Diameter_______ _ __________De tn___ <br /> ❑ Number of pits._.-1-------------- g <br /> Cesspool: <br /> Distance from nearest well------- --`-Depth Ce from foundation-----------------__Liquid Capacity_.- .---_--------------gals' '0 <br /> ❑ Size: Diameter -------- -------------------- ---------- <br /> 0 <br /> from.nearest well------------------------- _ -Distance from nearest building----------------- <br /> Privy: ---- ` <br /> i ❑ Distance to nearest lot ine------------------------------------------------ <br /> _.___-_..-_----- - <br /> 6 4 . <br /> - <br /> Remodeling and/or repairing (descri e):__________________ _ ------------------------ <br /> ---------------- <br /> _.--- <br /> -------- <br /> ---- ------------------- ' <br /> l - <br /> 1 --------- ------------•----------------------------------- i-11-_be------ ---_in-------------- ----------h - a <br /> ` i hereby certify that I have"prepared thi PPI, the Sand Joaquin ocal workHealltheDistrlctn accordance with San Joaquin County <br /> I ordinances- State laws, and-rules and regul I s <br /> -------------------(Owner and/or Contractor] <br /> I (Signed)----------------- -------------------------- ---------- <br /> --•-------- ---------- ---------------------------- <br /> By: = <br /> -(Title)---------- <br /> --------------------------------------- <br /> ------:----------------•------•------ <br /> (ple{ plan, showing size of lot, location of system.in,relation to wells,.buildings, etc.,.can be placed on reverse side). <br /> I FOR DEPARTMENT USE ONLY <br /> rDATE---------f- _ - ----------------------- <br /> I APPLICATION ACCEPTED BY------------- - -- --------- <br /> --------:------------------------ <br /> ------------------------------------------- <br /> ---------------•-- DATE-------------------------•------------------------- <br /> REVIEWEDBY-------------- -------------- - DA- ------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------•----------------- --------------------------•---------------_-------------- -----------•-------•--------------------------------- ----- <br /> --=----- ------- ------------------ ------- <br /> Alterations and/or recommendations' ..6 r --- =��`-------------------- ------------------- <br /> f -------------------------- <br /> -f - ---- -------- <br /> } ----------------------- <br /> ---------------- <br /> _.. - <br /> ----------------- <br /> -- <br /> -------------- <br /> - , - __..--- — .. Date.. ---- <br /> FINAL INSPECTION BY___________ �- <br /> � 'T -------------------- <br /> ___ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> West Oak Street W <br /> 300es <br /> 124 Sycamore Street 205 West 9th street <br /> 16o1 E.mazelton Ave. Manteca,California Tracy,California <br /> s Lodi,California . <br /> Stockton,California <br /> E5 9 REVISED a-$9 3M 3-'63 F.P.CO- <br />