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FOR OFFICE USE;++ f q� <br /> .:----- _u-%--------------- Permit No. .__1. _._ __l <br /> 4 APPLICATION FOR SANITATION PERMIT <br /> _____ _ (Complete in Duplicate)xpires 1 Year From Date <br /> Date Issued ---4- 1-2 (04 <br /> r —T- - This Permit Eissue <br /> ..... <br /> ------ <br /> d. <br /> Application is hereby made to thesSon Joaquin Local Healfh District for a permit to construct and install the work herein descn e <br /> This application is made in compliance with County Ordinance No. <br /> J08 ADDRESS AND LOCATI v-- ---••-------------------•-----------------•--•-------•-------- <br /> _ ---•--- PAX <br /> ell. !,P, <br /> :.. <br /> -----------------•------- <br /> Owners Name- <br /> ----------- Phone------------------------------------ <br /> f t� `-- ----•---- <br /> Address_.. -------=--- <br /> --------- - - <br /> y.. Phone------_---------------- <br /> ------------- <br /> Contractor's Name----------•-- <br /> - ---•-••-- <br /> Installation will serve: Residence g!� Apartment House ❑ Commercial°❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> �Number of baths Lot size _ <br /> -- lY--- ---------------------- <br /> Number of living units: __�-- Number of bedrooms __ ____. � <br /> Water Supply: Public.system ❑ Community system C1Private Kjo-'&pth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[�ardpan El <br /> Previous Application Made: (If yes,date--------------_.---) No ❑ New Construction-. Yes ❑. No E] FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r' <br /> (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic;ank: t Distance from nearest well_.---------------Distance from foundation--------------------Material-------------------------------------------- <br /> Size <br /> ---.___---__"---_------_ --____-"-------_-- <br /> t> .,f- yf G Liquid depth Capacity <br /> �! /i/J No. of compartments_ Size-------------------- ----- -- ---•---------------1- <br /> y��__�.__.Distance to nearest tat I�e__ <br /> Dis oral Field: Distance from nearest well...�Q----Distance from foundation." Width of french----.---- <br /> Number of lines-------- Length of each line-------- 7i <br /> t I1 I !! e th of filter material_--:' �-------Total length-__.�tr___.----••----------•----- <br /> Type of filter material_ <br /> P .._ <br /> -----------Distaoee to nearest lot li�_________________ <br /> Seepage it: Distance to nearest well____!��__--_ Distance f m fo ndaze. &+Q Depth-_--/Ap---_---.----__----. <br /> I Nurnber of pits. j,--- ------Lining material Size: Diameter <br /> 14 <br /> Cesspool: Distance from nearest well___------_----_--Distance from foundation____________________Lining material__________-.___.____----- ---------- <br /> ----------- <br /> -foundation <br /> Size: Diameter------- --------------- ------Depth---------- ---------------------------------------Liquid Capacity....------------------------q <br /> Privy: - -.-:--Distance from nearest building--------------------•----------- <br /> Distance from nearest well__.__" ., <br /> _., <br /> Distance to nearest lot ine-------______---------------- --------------------------------- <br /> i f J <br /> r deling and/or repairing {descbe} ____________________`_,,//�� <br /> --v--------- <br /> . __ <br /> Remo <br /> ---------•- ----------- <br /> --------- <br /> -------- <br /> ----------------------------------- - <br /> ------------------•----------•--- ------ <br /> I have done <br /> application <br /> the:San Jaaquin�LocalkHealltheDistrctn accordance with San Joaquin County <br /> f o � �� ------ ------------ -------------------------------------------------- <br /> (Signed) fbr <br /> t --� {�. Contractor) '+ <br /> � - g <br /> ----------- ------------- <br /> i _ ­_5 y----------------- - - ------- - (Title}-- �--------�-- --- ------------ <br /> Plot Ian, showing size of lot, location of s ste elation to wells, buildings, <br /> By: -- etc., can be placed on reverse side}. <br /> ( p _ <br /> FOR DEPARTMENT USE ONLY <br /> r APPLICATION ACCEPTED BY---__C, -- ------------------------- DATE---- -.-_.. t -------------------- <br /> REVIEWED BY--------------------------------------------------­----------------------------- ----------- ---------------------- DATE----------- --------------- --------- <br /> DATE----------------------------------------------------------- <br /> BUILDINGPERMiT 1SSU ED-------•-----=----- ----------------------------------------------------------------------------------- <br /> A1telations and/or recommendations:----• -------------- ------------------ •- ---•------•------------•-- <br /> tL�� '--Ok---------- C_�_ — •-----• 4- 4----•- <br /> --••---- --- <br /> I <br /> Date---- --------------- ------ <br /> ------ --------------------- <br /> FINAL INSPECTION BY:.'.f,,1-- ---Y" ---------------------I <br /> - --- - <br /> SAN JOAQUiN LOCAL HEALTH DISTRICT . <br /> 306 Wast Oak Street �,� i �} 144 Sycamore Street y 705 West 9th Street <br /> 130 South American Street _, <br /> Stockton,California <br /> Lodi,California Manteca,Colifornia Tracy,California <br /> r <br /> E6-9 peVj6Eo 6.59 F: =P.2M 6-6q <br />