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A <br /> APPLICATION FOR SANITATION PERMIT Permit No. ./'4..._ <br /> (Complete in Duplicated <br /> Date I55ued /,//5=y__ <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 application is made in compliance with Count,,�Ordina±a,!Fe-Rfo. 5 ------------- <br /> 4 . <br /> 0.1 <br /> JOB ADDRESS A TION... � XJ -' '"" �� � �--��---� <br /> —- Phone d <br /> Owner's Name --------- = -------------- <br /> Address-------------------------- -- ------- -' <br /> Contractor's Name. - ----- ---- ---------------------------------------------------------- Phon --•----sem. ------- <br /> Installation will serve: Residence FE-.84--`Apartment House,❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:-_"Y- Number of.bedrooms___?_ Number of baths - Lot size ------ -7 r-__ ___ -x29 <br /> ________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ *,Gravel ❑ 'Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No ew Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> o septic tank or'cesspool permitted if public sewer is available within 200 feet..} <br /> e tic T Distance from nearest well_________________Distance from foundation--------------------Material-------------.--------------._______..____--.___. <br /> No. of compartments--------------------------Size---------------- ------------Liquid depth--------------------------Capacity-•-- ------------ <br /> Sal �E.'e 'Fance from nearest well---------- -------Distance from' foundation--------------------Distance to nearest lot line.-_______________ <br /> Number of lines--__`--------------------- ----Length of each line------------------------------Width of french--------------------------.._--_--- <br /> �( Type of filter material_.____f------------------ of filter material-----------------------Total length-------------------------•---------------- <br /> Seepa.e Pit: Distance to nearest well__"_______ ______Dista om f undation--- -4?�_........Distance to nearest lot line.... <br /> 00 <br /> Number of pits--------�__.__------Lining material________ _______ Size: Diameter__0.�3--------.Depth��.A-37 ------------•- <br /> Cesspool'- Distance from nearest well_________________Distance from f undation.-.__.___--____--_._Lining materiil-------------------------------------- <br /> ❑ Size: Diameter----- ------------------- ---Depth-----------/------------------------------------Liquid Capacity----------- -------gals. <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building-------------------------•--------------_. <br /> ❑ Distance fo nearest lo+ line--- -- ------------------------------------------------------------ <br /> Remodeling and/or repairing (describe):- ---------------------Z----- -----•-------------- ` <br /> --------------------------------------•-----:------------------------------ --- --------- A------ ----- `�-" <br /> ------------------ --------------------------_:_ <br /> I hereby certify that I have prepared this application and +hat thAwork will be done in accordance with San Joaquin County <br /> ordinances, St a laws, and ules and regulations of the San Joaquin Local Health District. <br /> (Signed} 1/�-- - tI'-C. -------- ------_ _ .,*Contractor] <br /> f <br /> (Plot plan, showng size of ot, location of system 1n relation to weds' uildings, e� , can be placed on reverse side}. <br /> FOR DEPARTM9NT USE ONCr <br /> APPLICATION ACCEPTED BY-------`-"_� _K,--Da--------------------------------------•----•----------------------- DATE----- X{ r � <br /> REVIEWEDBY------••----------------------------------------------------------------------------- -------------------------------------- DATE-------- ---•---------•-----------... <br /> BUILDING PERMIT ISSUED------------- --------•-----------------------------------------------•------ ------------------------ DATE.------------ -------•------------------- <br /> Alterations and/or:recommendations:---------------------------------------------------------------------------------------------------------------------------•----------------------------------- <br /> --------------------------------------------------------------- <br /> -4---------------------------------------------------------------------------------------------------------------------------------------------•------- <br /> ----------------------- 1-T Er 4-------- z liV S_P TiP[ i <br /> -------------------------------------- <br /> ------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- ---------------------•---­ <br /> ----------------------------------------- <br /> •-- ------------------------------ ----- ------ ------ ------•--------- ------------------ ----- ---- --------------------------- ----------------------------------- <br /> FINAL-- <br /> -------•-------------------------FINAL..INSPECTION ..--- / rte <br /> Date-- ---- _ <br /> 1 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> i <br /> ? ES-9-2M Revisea ).57 F.P,CO. <br />