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APPLICATION FOR SANITATION PERMIT Permit No. .__/ �. / <br /> (Complete in Duplicate) Date Issued ---- <br /> 77��1`S-L & <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permitxto construct and install the work herein-1.escribed. <br /> This application is made in compliance with County Ordinance N . 549. <br /> �. , „r.- v <br /> Z f o <br /> JOB ADDRESS AND L ATIO --- �/ •-- -= '----------------------------------------------------------------------------------- <br /> { <br /> Owner's Name-------- - -- --------- Phone------------------------- ---------- <br /> Address----------------- / ----------------- = f ��, ------------------------------------------------------------------------------------------------------.. <br /> Contractor's Name • - y_ s ------- ------------ = Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑Y� Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ __ mber of bedrooms{. _ Number of baths __I__ Lot size .�iD_!1(_r.1A9011_______________________ <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 E] Clay Loam ❑ Clay ❑ Adobe vle<ardpan ❑ <br /> Previous Application Made: Yes [) No & INew Construction: Yes ❑ No 9?/THA/VA: Yes ❑ No Ry- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ,. <br /> (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) <br /> 5 fiic -Fa ' Distance from nearest well------------- Distance from foundation--------------------Material____.___._._________-_ _________..__________- <br /> �07;V No. of compartments----------------- --Size---------------------------- ---Liquid depth----------------- --------Capacity-•---- ----- -- <br /> Disposal Feld: Distance from nearest well--all-[/;.!_Distance from found t' _ __fes Distance to nearest I t line-id��' <br /> r <br /> ----------- <br /> ���� Number of,lines______________ g � // <br /> __ _ _Len Length of each line_____ _ -___r___.______.Width of trench____ ___ __.___..__.__._ <br /> De th of filter material �j____-__Total length __ _�_____ <br /> Type of filter material- �- i p g _------ <br /> %a e F Qistarce to nearest well__ __ __g: __-Distance f m foundation _- <br /> �P't,� �� _; * � ___:IJis# �e to nearest lot line__ ______-. (f <br /> f Number"of jts---- sf . <br /> i p �_____ __.___Cining material, _ ._size: Dia meter _.__...___Depth_.~!___.._ <br /> Cesspool; Distance from nearest well-----------------Distance from foundation___________ _ <br /> _______Lining material____. ________-__-_-.___________ <br /> �, ❑ Size: Diameter-----�- ----------------------- Depth---------------------------------------------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest wefl------cy-----_--------------------------------Distance from nearest building----------------------------------- <br /> k <br /> Distance to nearest lot line = ------ ----- --------------------------------------------------------------------------------------------- <br /> .❑ <br /> Remodeling and/or repairin (describe)------------------.-- _---------___ <br /> -- <br /> m 1 - <br /> ____ <br /> _._ ________________________________________ ___.______---_.____-__=__________________-_________________________________-_-_-_____________.______.________.__----- -_------.____---_____ ___________________ _ ___ <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 rules and r lations of the Sayf Joaquin Local Health District. <br /> (signed) i -- -- - --- -- ------ ---------- --------------------"---(�r Contractor) <br /> BY: - --- ----- "_�-----------[Title)----- • <br /> [Plot plan, showing size of lot, location stem in relation to we Is,'kiuildings,etc:, can be placed on reverse side). <br /> s <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ =•---------,<-W------------------------------------------------------------ DATE----�7--`c95------6 <br /> REVIEWEDBY----------------------------------------- -- ------------------- ---------------------------------------`-------------------- DATE-------------------------------------- ---------- --------- <br /> BUILDING PERMIT ISSUED---------------------------------- --------------------------–---------------------------- --------- DATE----------------------------------------------------------- <br /> Alterations and/or repo mm `rd a tions:-------___- <br /> -- ------- ;1 - -4- ---------- ------------------------------------- <br /> FINAL INSPECTION BY:..-._ -`-_L --- ..-___-- Date---- -------- . <br /> SAN JOAQUIN,LOCAL HEALTH DISTRICT, <br /> r� 130 South American Street 300'West qak Street 132 Sycamore'Street 814 North "C" Street <br /> f Stockton, California Lodi, California' '� Manteca, Californ e_+ Tracy, California <br /> z <br /> ES-9-2M Revised 8-'59 F.P.Ca. <br />