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F R OFFICE USE- <br /> �� - ------------ /_7..�a- <br /> Z.�_ 'r �� - APPLICATION FQR SANITATION PERMIT Permit No. -._-•_ <br /> ________ --------------- I {Complete in Duplicate} .. _ :, :-� Date Issued ___� �� /--� Y <br /> I. -This Permit Expires 1 Year From Date Issued � ' <br /> --- - --- --- ---- x <br /> Application is herebymad to the San Joaquin Lo <br /> cal Health District for a perto�construct a�install he in described. <br /> This applicatio made i co ianO ce No. 549.JOB ADDR S OCA <br /> ' r '� ' '�4 �1 - ,.�tx.-[a ---------- <br /> i ---------- PhorD� <br /> Owner's Name_ <br /> •------- p <br /> ---------- <br /> Address--------_----•---- = x........... 14 <br /> - Sl! T� <br /> ; <br /> ' � Phone -..> <br /> Contractor's Name.- <br /> Motel <br /> it <br /> Installation will serve: `Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motei ❑ Other ❑ .2 <br /> - <br /> 'Residence <br /> of.living-units: Number,of bedrooms,;__ Number of aths _ .___,Lot size___________ ___-____._____ .....�� _ <br /> Q ft. <br /> Water Supply: Public system ❑ lcom' munity system ❑ Private Depth to Water Table <br /> Character of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ e Hardpan ❑ <br /> 00 <br /> IINo FHA/VA: Yes E] No E]Previous Application Made: {If yels,date-----_______________! No F1 New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool;permitted if public sewer is available within 200 feet.) <br /> �l <br /> tic ki� Distance from nearest well-----------------Distance from foundation-------------------Material________ _____________________________ ______ <br /> No. of compartments---------- ---------------Size-----=•------------------------Liquid depth <br /> Capacity------ ---,�-,-�----r-�-- <br /> IPT, <br /> Distance froml�near st well, --.Distance from foundation__�_---________-.Distance to nearest lot line_Length of each line----- �3 Width of trench.----- <br /> Number of lines----�--__ ---- ------ - 9 40 ,mss <br /> �. Type of filter material ___ -__ __Depth-of filter materlal'_____I i_- ------ <br /> length_._____ d---------------- -- <br />} IM ---Distance to nearest lot lire R�/ <br /> Seepage Pit: Distance to Weare t well) b2�-________Distance t;J <br /> oundation - <br /> -----Linin material_ ------Si iameter_ -._�!FDepth-- -t---'--------- *r <br /> �J Number of pits....I---------- g <br /> V' Lining material--------------------------=--------- <br /> Cesspool: Distance from nearest well_________________Distance from oundation----___-_-_ <br /> ❑ Size: Diametel`--------------------------------------Depth------------------------------------- Liquid Capacity gals. <br /> Privy: Distance.from nearest well-------------------------------------------------Distance from nearest building-------------------------- r. <br /> ❑ Distance'to nearest lot line-------`------------------ --------------- -=------------------------------- -------- <br /> ----------- <br /> ------ /,. <br /> gg <br /> Remodeling and/or repairing (d I�cribe}: :_ --------------------------•---------------------------------- -------- ----•--•-------•----------------------•------------ <br /> -------------------------------------------------------- <br /> .I:--------"------------------------------------------------------------------------------------ --------------------------------- <br /> FI _________________________________________________________________-__---- <br /> ------------------ <br /> ----------------------------------------- <br /> _-_ <br /> _______________________________________________________II�___.____.________._______.___._______________.-_______._______________-_______..______.. -__-_ <br /> y <br /> I hereby certify that I have Qrepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta+e ws, and rules-[and regulations of the San Joa in Local Health District. <br /> ! r Contractor) <br /> (Signed)------ - tkf - -- <br /> is (Title)_ -------- -------- <br /> (Plot plan, showing size of lot, loc tion of systern in relation to , buildings, e+ ., can .be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> I c -- 1 <br /> APPLICATION ACCEPTED BY-1-- DATE <br /> REVIEWED BY DATE---------•-•--------•----------------------------=-------- <br /> I!_ <br /> ------------- -- --------------------------------------------------- <br /> BUILDING PERMIT ISSUED--------- ----- ---=------------------ ------------------ - _ DE----: = <br /> Alterations and/or recommendations:_.------ /- '- -- -- ---------- ti _ - ' <br /> ----- ----------------------- 14- - <br /> ------------- <br /> -------- - - <br /> �� e- --•------ <br /> - ---------------------•----------------------- ----- ----- <br /> FINAL INSPECTION BY:....... ----•-------------- ---------- - ----±- Date-- ------------ ----------'---- ------------ --------------------------------- <br /> 'k- ---= - <br /> I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:allon Ave. I� 3oo West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,CaliforniaLodi,Californio­�- Manteca,California /I Tracy,California <br /> ES 9 REVISED g-59 3M 3-'63 F.P.0 �. i <br />