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` FUCK QFFICE USE. t <br /> --- ----- -- �- <br /> �' "- .-_.._____._ APPLICATION FOR SANITATION <7 <br /> PERMIT Permit Na. ....�cz�.............�_ <br /> ----------------------------- -------------------------- (Complete in Duplicate) j <br /> ------------------- ----- ----- - -- - -- - ----- ----- This Permit Expires i Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. <br /> This application is made in compli nce with County Ordinance No. 549, �� _ ZorOj n/ITC , <br /> JOB ADDRESS AND L CAT ...�---1'7E&CH- 11_ -- _ ZE70 J----- t Esc -r D <br /> _ <br /> Owner's Name _ �� --•• /1fj!+r x <br /> - - Phone------------------------------------ <br /> AddressQ.- 1 --------�--`-`--�_�� ------- � - <br /> Contractor's Name--------------------------!--7--- # <br /> - ---------­-------- -v - --------------� �='---------------- Phone—-------••----- ----------•------• <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial �ailer Court❑ Motel ❑ Othe ❑WASHES <br /> Number of living units: -------- Number of bedrooms ___---__'Number of baths _______ Lot size `ACF E76 �--------------- <br /> Water Supply: Public system ❑ rCommunity system ❑ Private [Depth to Water Table f5 ft. r f <br /> Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan (] <br /> Previous Application Made: (If yes,date--- ___r----------) No RNew Construction: Yes D—Iqo El FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> --(No septic tank or cesspool'permit+ed if public sewer is available within 200 feet.) <br /> Sepk: Distance from;nearest well__ 1 Q-___Distance from foundation__ .__/0-._____-Mat r �V_ <br /> iaI__CPCRC—T�------____-" <br /> No. of compartments------- _____._.._._-Size 2�X-6_. -._Liquid _._ -------------Capacity__3p aQ__-__ <br /> I <br /> Disposal Field: Distance from earest'well__ ..r� Distance from foundation_740_"".:Distance to nearest lot line______. <br /> Number of lines------- _ --- ti �(---- s ' r� <br /> I _,: Length of each line = . Width of trench --------2y-------------- <br /> Type of filter material__._____._ -Depth of filter material„^ ?. ._-:_- _Total length_-..__:-ZD-0 <br /> __ _ -- _____--- <br /> n <br /> ---------- <br /> eepage Pit: Distance to nearest w6f_--------------------- <br /> Distance from foundation____--------_* �_ Distance to nearest lot line__.----__________ <br /> ❑ Number of pits--------------- __Lining material---------------'__---.Size: Diameter_'-------------------- Depth.......-------------------------- p <br /> Cesspool: Distance froml neare§ well_____.___._____Distance from foundation--------------------Lining material--------- ---------------------------- <br /> El <br /> ____________________ .___,❑ Size: Diameter A'- Depth -----------------------Liquid Capacity------ gals. <br /> Privy: Distance frominearest well_______________________-------- <br /> -------------.--.-Distance from nearest building <br /> -------------------------- <br /> ❑ Distance to nearest lot lire--------------------------------- - - <br /> ----- -------- ----- ------------ <br /> Remodeling and/or repairing: (` describe]:. r- + <br /> i ! t ; - <br /> -------------------------------------------------'--------------------------------------------------------------------------------- ------- ---------•------------------------------------------ <br /> I- „ � � I + <br /> ---------- ------- ---------- ----------------------------------------•---------- -----------------------= --------------------------- -------------------------------- <br /> -------- <br /> ----------------------------- <br /> 1 heieAyIcehify that I eye prepared this application and that the work will be done in*accordance with San Joaquin County <br /> ordinances, State laws, and rulei and regulations of the San Joaquin.Local Health District. <br /> (Signed) i— ---------------------- <br /> 4 )Owner and/or Contractor) <br /> a <br /> --_ <br /> _ 1 <br /> BY: - {Title}>==-............. -.- — = <br /> {Plot plan, s wing s' of lot, Iota tan of system in relation to wells, buildings,jetc., can be placed on reverse side). <br /> { <br /> FOR DEPARTMENT USE ONLY <br /> 77 <br /> APPLICATION ACCEPTED BY--- L_.t_ _. --------------------------------------------------- ------------------ DATE------ _`- .._' ---------------- <br /> REVIEWEDBY----- --------------------- ------------- -- ------------------------------------------------------------------------------ DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------- ----------- "------------------------------------------------------------------ DATE--------------------- <br /> .;. <br /> Alterations and/or r commendations----------- ----------------------- ---------- ------------------------------------------------ ---------_------------------- - -- ----------------- <br /> ----- a. /Er- rn� pcTq oca - --- ---- --- e.►� <br /> ----------I-------------- ------------------------ ----------- <br /> ' . t -- <br /> --------------------------------- - ----------------------------;---- - ------ -------------------------------------- --- ---------------------------------------------------- --------------------------- - ------ <br /> FINAL INSPECTION - ._�.. - - - Date-----------------'Q 4 4Q --- ---- -" ---------------------------- <br /> S JOA UIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.C u. <br /> si <br />