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FOR OFFICE USE: <br /> ---------- <br /> ------------ APPLICATION FCR SANITATION PERMIT Permit No. ...: .... <br /> ------------- ---------------------------------------- (Complete in Duplicate) �- f <br /> _________ ____:___ ___,,__-s.__.._____.__..:.__. This Permit Expires 1 Year From Date Issued <br /> 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 application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND C ION- ,t� -- •-------------------• -----••-------------- <br /> --O'�- ---�-�-----� -�--------- - � -------------------- <br /> Owner's Name........... <br /> ...... c' Phone------------------------------------ <br /> Address <br /> - <br /> 7 <br /> Address------------------- ------ . •--•-- r / /�----- `' ,C _7 ---------------------------------------------------•---------------•---••---- <br /> Contractor s Name______________ <br /> • ----_-. ... ------ Phone... <br /> Installation will serve: Residence [6r--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ Number of bearooms _ Number of bathsm-;!� Lot size ______________________________ <br /> _ _____ ___ <br /> Water Supply: Publics stem <br /> y �ommuriity system ❑ Private ❑ Depth to Water Table *- 7 ft. ! <br /> Character of sail to a depth offi3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8-'-Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------1 No gg-O'New.Construction: Yes 52,'No ❑ FHA/VA: Yes Z TVo ❑ - <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septiclank or cesspool permitted if public sewer-is available within 200 feet.) <br /> Septic Tank: ,: �"'—Distance�from nearest wet __`__ _ <br /> _ ___Distance from//foundation__f ___-_Material-- _4/_ �'`� -------- <br /> [� No. of compartments-.------------------Size X i( quid depth___ .___...-._-._--_Capacity_`ip-___ <br /> Disposal Field: Distance from nearest well-_-- .__._-Distance from foundation.---�a;._--_-Distance to nearest lot line.-_e�-____ { <br /> t _ T <br /> Number of lines__:= -Length of-each line__ � �_ __`____.Width of trench_ ----------------- <br /> -- <br /> ___ _______. <br /> ------- <br /> Type of filter material i s e th of filter material - -------Total length-- --------- - . <br /> �__.-__Distance fro foundation-___ . <br /> - f <br /> Pit: Distance topeare�well___._... g � �___.D st nce to nearest lot line___.._ <br /> Seepage/ <br /> Number of, its___ _________________Linin material____,167 __-Size: Diameter_ -------Depth_ <br /> Cesspool: Distance from nearest well-----------------Distance from <br /> . . foundatio-:-n--__--.-__-__,-<------Lining material----__________________________._._._. <br /> ------ ---- ---------' ---- --_-- -- -_Liqu�d Capacity_ gals.Size: Diameter-C` -__-____----------- <br /> N <br /> D�stance from <br /> st <br /> Privy❑ Distance to earestelot linie_______________________________ .---- ----------------­-stance 17._nearest building.---___._:_------ ___-----._--- __-_:--_:. <br /> Remodelin and cr re airi,ng (describe):---------- - -- ''--•-------------------------•------------------------- �y <br /> f <br /> ----- -- - - - - - - - - <br /> " � i <br /> ------------------------------------------------------------------`-----------------------------------------------------------------------•-----------------------------------------------•-------------------------------- �'wl <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--regulations of t e San Joaquin Local Health District. a <br /> t <br /> (Signed ------ --------------' ----------1 = � - � <br /> ------------------------ or Contractor) <br /> 4 <br /> . k y - 6 -----------=----------------- -------- Title <br /> ----------------- <br /> (Plot plan, showing size%bf,lot, location of system in relation ells, buildings, etc., can be placed on reverse side). ' <br /> a. FOR DEPARTMENT USE ONLY ' <br /> / t�c-z�-.�-- 2 "- ----- --f-- --- - - - <br /> �f l` <br /> APPLICATION ACCEPTED BY--'----�=���-------- ------------- ---------- ----------------------------------------------. DATE- -------- <br /> - - ------------- <br /> REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------------- DATE---•---------------•-----------•---------------------------- <br /> BUILDING PERMIT ISSUED ------ <br /> -------- ---------------------------------------------------------------- DATE------------------------------------------ --------------- <br /> Alterations <br /> ---------_-='Alterations and/or recommendations: -'�T --��---- �-'"-�'�-- __1----- L�' �`'-�~'C_�� •--'-- # <br /> U <br /> G r ll tiL2�' tiC- t ref <br /> -------------- M - -' `" r-c-rz � <br /> _ _ r <br /> ' -----------te-J K-�------------------------------------ -----------------------------1 6 <br /> F r ✓� � V •- <br /> ------ <br /> FINAL INSPECTION BY:_... ---r,A <br /> ---------------------------- Date------- ---------- ----- ------------------------------------- <br /> --- ` ` <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124'Sycamo4 Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,Colifomia Tracy,California � <br /> ES 9 REVISED 5-59 3M 3-•63 F.P.CD. <br /> .r <br />