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FOR OFFICE USE: <br /> --------------- ---I........!_­------- -- --------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> ------------ ---------- ­­------------ --I I <br /> -----------------­-- ­-------------- - --------- [Complete in Duplicate} d <br /> Date. Issue <br /> --------------- ---- -------------------------------- This Permit Expires 1 Year From Date-issued <br /> A hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> , <br /> Application�on ii 5 -707 — 0( 1 <br /> a p [cat on.is made incompliance with County Ordinance No. 549. <br /> ',7 ------- W------ <br /> JOB-ADDRESS AND LOCATIOP_ <br /> Owner's. Namel--------------- ----------- - ------- ------- --- ----- / e=------7 <br /> qg -------- ------- -• <br /> -------- <br /> Addre' L3-. <br /> ----------------------------- ---------- -------------_----------- <br /> -------------- .... Phoneg ----- <br /> Contractors 1`4ame_OkCL-- _ ------- _C� <br /> Installation will serve: Residence [I Ap6rtment House 0 Commercial El Trailer Court 0 'Motel 0 Other <br /> "Number of living units: Number of bedrooms -------- Number of baths -------- Lot size ----------------- <br /> Water,Supply: Public system.E] Community system [] Priva teA Depth to Water Table?Q ft <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam,[] 5'ay Loam o Clay ❑ Adobe E]- Hardpan E] <br /> FHA VA: Yes ❑ No Ej <br /> Preyioi6ls.Application �(lf yesdate'.-: IN 6K New Constr'uction: tYs No [E] <br /> r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ._, <br /> Septic Tank::',! Distance from nearest well/30ig"isfance from ----~Material._._-------------------------------------- -4g <br /> No. of compartmenfs_____- .ir _,...........Size----_ ----------Liquid depth____.,50'( CapacityZA_�o- -------- N <br /> Disposal Field Distance from nearest well/3o:AL-Disfance from foU ndation-4-01— -.Distance to nearest lot linel ---------- <br /> Number of lines Length of each line------40-13-f�-_----.Width of trench -------------------- <br /> Type of filter maferiadVtS-6�Z Depth of filter material---14 _11----------Total lengih_4-`1_ ---------------------f--_---7 - <br /> f <br /> Seepage Pit:x Distance to nearest well__1_0_0­.. Distance from foundation-_GP- _Dista nce'to nearest lot lir)qe_k ......... <br /> Number of pits------- -----------Lining material Size: Diameter--.1 Y,-:�- ---Dep0_12--lifft,---------------- <br /> Cesspool: Distance from nearest well ------------------Distance from foundation.__._----:--_- ..Lining material.----------------_._----------------. <br /> ------------------ 11111— <br /> iquid Capacity-----------------------_-_gals, V7 <br /> Size: Diameter- -- --------- -- -- -------- -------Depth-------------:---------------- - - -------------_L <br /> Privy- 1. Distance from nearest well------------------- ------ ------------ -Distance from nearest building-----_-____---------__-----.___---_-----. <br /> I <br /> i <br /> 1 1:1. Distance to nearest lot-line ------------------------------------------------------------------ - - -------------------------------------------- <br /> F <br /> Remodeling arild pairing (describe):----- ----------- -------------------------- <br /> -------- <br /> /or re <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------ -------------------- --------- ----------- <br /> -------------------------I-------------------------------------I------------------------- -------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- <br /> - I --------------------------------------­--------------------- <br /> - - -- -------------:-------------------------------------------------------------------------------------------­--------------------------------------- <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (-caner-an d/or-Gonfra ctorl <br /> r(Signed)- --- ---- --------- ------- - - - -------------------------- <br /> . reverse side}.. ........ <br /> By:--.- - --- ---- ------- ----------------- --- ---------- - ---------------------------- --------[Title)- -- <br /> -- --- <br /> (Plot plan, showing size of lot, loc�a+i, c, system in relation to wells, buildings, etc., can be placed <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION'ACCEPTED BY---r-7_R_10-4------- -------------------------------------------------------------- DATE-----140- ------------------------ <br /> REVIEWEDBY---------- -----------------------_-_-1----------------- - ------------------ _-------------------------- DATE----- ------------------------------------------------ <br /> BUILDI`NG PERMIT ISSUED-------- ------------- ------------------------------------------------------------- ---------------- DATE--------- --------------- _------------------------------- <br /> Alterations <br /> ------------------------------- <br /> Alterationsand/or recommendations:--------------- ---- --- ----------------- ------ --------------------------------- ---------------------------------------------------------------- ------- <br /> ------------- ------- I ------------------------------------ ----------------------- -------- ------------------------------------------------------------------- --------------------------------------------- <br /> ........................... ------ ---------------------------------- ------------------------------------------------- ---------------------------- ------------------------ ------------------------------------------- <br /> k <br /> ------------------------------------------ <br /> ------------------- ----- -------------- --- - ---------------------^-------- ------------- ----------------------------- ...... -------------- ---­------------ <br /> - ------- --------------------------------------------------------------------- -- ----------- <br /> .......... - ----------_--------------- ----------------- <br /> Date--- ......... -------------------------- <br /> FINAL INSPECTION Ivy,— <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />