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FOR OFFICE US : <br /> f <br /> ` '•-t•A--- 1 i`` ------------ W* <br /> 1f Permit No. ---• <br /> APPLICATION FOR SANITATION PERMIT <br /> ___�__-__ ___ _ _I - ------------- (Complete in Duplicate) Date Issued <br /> ------------ his Permit Expires 1 Year From Date Issued <br /> Applica on is hereby made to the San Joaquin Lacal Healfh District for a permit to construct and install the work herein descrbed. <br /> This.application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..:. 9L— -.Cl---H_t---- G_6z ?..". ------- L <br /> Owner's Name--------•-------•- ---•--------•----------------------------------------- Pone = <br /> A � <br /> Address--------------------- --------- ------------------------------------------- ----=-------- . <br /> ------------- -------------- ------- -------------•••---•-... <br /> ---------- <br /> } <br /> Phone..--------------------------------- <br /> contractor's Name---- --------- Ph <br /> it 1A s p ❑ ❑ ❑ Motel Other El <br /> Installatio_n will serve: '.Residence A artmentwHouse Commercial Trailer Court ❑ <br /> - (� % '^r 1 7 -------••----•- <br /> '\ plumber ofiliving uni#s: ____ . Number of bedrooms=__ _ Number of baths _,_�__ Lot <br /> size . " ' ."1 <br /> Wafer Supply:j,jublic system EJ Community system ❑ PrivateA Depth to Wa#er Table .��ft. <br /> ,.j j Y.4 i <br /> Character/of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe HardpanjK <br /> f Previous Application Made: (if yes,date____________________) No ❑ New Construction: Yes I-] No ❑ FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if,public sewer is available within 200 feet.) <br /> tic k r Distance from nea est well_________________Distance from foundation----------------.---Material,__.______--"_____...:..______-""___.______--_- <br /> No. of compartments -•-------.Size--------------------------------Liquid depth--------------------------Capacity------------------•---- <br /> =' <br /> Disposal i d: Distance from- nearest well-._.:._.Distance.from foundation____. `__.____Distance to nearest lot lin ................ <br /> of <br /> Type ofj4il et maferial_ � -Depth offfilterlmaterial.f 2/91!­-___-----a.""Total filen th�G�..___!_ <br /> Seepage Pit: Distancef <br /> to nearest -------Distance from foundation-------------------.Distance to nearest lot line_____--"_______.- <br /> ❑ Nember of pts ------i--Liningymaterial Size; Diameter Depth <br /> Cesspool: Distance•fron) nearest well ___=\.______-Distance from foundation________________._.Lining material.---_-____________-_-.._-_________-. <br /> ❑ `----. De th= ------------•-•--------------------------------Liquid Capacity---------•-----------------gals. <br /> Size: Diameter---------�-------------'-'-------- P - <br /> Privy: Distance from nearest well:--k__ ------ ---------------------- from nearest building------------------------------------------ <br /> -, :._. w -. ._. ------------------••-------------------------------------------- ------------ <br /> Distance to nearest lot line__------r'tf---------------- ------ <br /> -----------K <br /> Remodeling and/or repairing (clescribe)-------------------- --------- ------------------------------ ------•-------------- ----------------------------------- <br /> ----- <br /> -- •---------------------------- <br /> i ------;----------------------------------------------------------------------------- t <br /> ...... :------------------- <br /> S - -----•-•---- ----- <br /> o , <br /> ----- <br /> L <br /> •------------------- <br /> 1 hereby certify tkat lihaveprepared this applicafion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State.laws; anaii rules and regulations of3th'eSatf Joaquin Lacal Health District. <br /> v <br /> ( / Contractor) <br /> l <br /> (Signed). _-=X_" .r.>`", Ile�- -----4`/�-----�� :-- - - - - � Owner and/or or <br /> I - system <br /> m relation to wells, buildings, Title <br /> ------------ -----------------------( } <br /> Plot plan, showing size of lot, loc •-• s t ---in - - - <br /> ( p g t, location of sy �ildings, etc., can be placed on reverse side). <br /> FOR DEPARTM T USE ONLY <br /> APPLICATION ACCEPTED BY____ ____ --_______ -------------- / <br /> E ------- ----- - ------------------------------------- DATE---------- -�-A.,-7--. t <br /> REVIEWEDBY------------------------ ----= - -------------•-•-- DATE------------------------------------------------------------- <br /> _ �Y -� EBUILDING PERMIT ISSUED----------------------------•--------------- _1` t= <br /> """ ------ <br /> Alterations <br /> and/or recommendations:-,-. ��= "" <br /> - <br /> �'—�-• .cis n <br /> sus -� -- r <br /> i ------------- <br /> -- - --------- ----------- - --------------- ----------- -------------- ------- - ------------------------------------------------- <br /> FINAL'•INSPECTION 'BY:_._ ------ '�-�`""�� <br /> Date....-- �ZZ ------- ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street. 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 REVI6E0 13-59 f.P.r Q.$M 6.60 <br /> Ik <br /> 1 - <br />