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FOR 0 <br /> 1 <br /> 1 <br /> 1C 117 <br /> - --------- <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit.No.�---�_j__:3. Y <br /> -------------------------------------- -- --------------- <br /> (Complete in Duplicate) r j <br /> Date issued ___�_________________ <br /> ___.:__.____-__----------------------------------------- This Permit Expires 1 Year'From 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 applicafion is made in compliance with County Ordinanc o. 549. <br /> t <br /> JOB ADDRESS AND TION.-�� . ---__-- ---- --gi _____________ r <br /> -------------------------------•---...__.-_-------------------------------- <br /> Owner's Name--------------- - - •-----• - - - Phone-----•-------------•-•- <br /> Address.......--- ------- � ; <br /> - -------------------------------- --------- --- ----- ------ <br /> /y� - -----------------•--- <br /> Contractor's Name---- _-.._ . . ... � N ` 7-f - -----------•--- phone.. ----------------------- <br /> Installation will serve:. Residence EP--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I <br /> Number of living units: _/__ Number of bedrooms&_ Number of baths/ Lot size __/W -s"o V_____________________________ <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table _ tt. <br /> Character of soil to a depth of'3 feef: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®/FTa•rdpan ❑ <br /> Previous Application Made: (if yes,date---_-------_--------1 No ® New Construction: Yes Imo❑ FHA/VA: Yes iib ❑ <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_: Distance from foundation_-- srC` .._-:_ <br /> ®� No. of compartments--g ----------------Sixe_jXx_-!VL9--------Liquid depth_____ _-�-_--------Capacity___X2�1L2__ <br /> I Disposal Field: Distance from neares well----- ------Distance from foundation__ .........Distance to nearest lot line_A'_._.__. <br /> 0� Number of lines_____ _____ _ ___Length of each line-__-� �f <br /> -- - -- -�-------f�----.Width of trench--a-----�------------------- <br /> f yp ial� �Q Depth of filter material___ ________Total length_ ________________ <br /> Seepage Pit: Distance to nearest _ �• ". ' <br /> T e o iter mater <br /> well______'r�______Distance from foundation___. <br /> ` �/� r'r50•_=____.Distance to nearest lot line____________ <br /> F [ � Number of pits---.--�----------Lining materiai.,�v_G.�L�Size: D•sameter.-:_��____.__Dept h: o `!_______________ <br />� Cesspool: Distance" fl•om nearest 'well----------------- frorri:foundation__--------_----------Lining material---------------.------------__-._____ <br /> ❑ Size: Diameter------------------------------------------Depth------------='-------- -=-------------------------Liquid Capacity----------------------------gals. <br />� Priv Distance to nearestel•+ I n�e---------------------------------------.___._.__Distance from nearest building-----------------------------_,.!_-_____-. <br /> Privy. .' <br /> El <br /> A. <br /> Remodeling and/or repairing (descri4�e�: - <br /> ... •---- --- ------ <br /> ..__________________________________________ _________________________._____________.________.________.___._._----__ ____.__.._____..._____.__.___._.-_______._______.._--------------------- <br /> ..............I------------------- <br /> ---------I..........I------ <br /> --------­1----------------- ------ <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 rul s and regulations of the San Joaquin Local Health District. <br /> . ^1�, <br /> (Signed)------------------- --------,T.. " -- ----- --------------------------------------- /- or Contractor)' <br /> �r <br /> By:--------------- -- --- ----- - -- -- <br /> �1; <br /> - - - -- -=------•----t---(Tiffs}-- ��.. :��,.---'------ - <br /> Plot Ian, showing size of lot, location of s stem ' lationato i fills, �lildm�s etc., can be, laced on reverse side <br /> I p 9 y 9 p )• <br /> FOR DEPARTMkI T�IJSE ONLY <br /> APPLICATION ACCEPTED BY-- -- -- { - -�y ---------- <br /> �.. __ �= =------ if ` s F DATE� �--"-'�,"---� '--- �'- �--------------- <br /> REVIEWED <br /> --- <br /> REV I EW ED BY--------- ----------- ---------------- ---------------- --- HATE i -------------------------------------------- <br /> BUILDING PERMIT ISSUED-----------•--------------------------- ------- ,�t DATE --------- <br /> ------------------------- <br /> -- -- <br /> Alteration andf or rer�orn ndaitions•---_------ ' f` ---------•---------• ------------- <br /> • ------ -- <br /> + "- "�-.f/-t� ------ ----••- -- <br /> ---- --- - ------- - -- -- - ----- ---------- <br /> 15 A <br /> ate-z.FINAL INSPE ------------------�----f--p------I- <br /> --------------------- <br /> { <br /> SAN JOAQUIN:LOCAL HEALTH DISTRICT, - <br /> 130 South American Street 300 West Oak street ti 124 Syianiare Street 205 West 91h Street <br /> :.. <br /> Stockton,California Lodi,California -;a­.Monfeca;California Tracy,California <br /> E8-9 REVISED 9-59 F.A.C .2M 6.60 <br /> 'y, r:r• <br /> 3 'i <br /> . - ., r'..-.. c•��f}� r�'.�,4rec�9f i�i'' ..iii-eiV+�..� , <br />