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FOR OFFICE USE: <br /> ----------- --------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------- --=---------------- _----- <br /> F-,.- <br /> (Complete in Duplicate) Date Issued <br /> ----------------------------------------------------------- This Permit Expires I Year From Date Issued i <br /> Application is hereby made.to the San Joaquin Local Health District for a permit to construcf_pLr)djnstaII the work herein described.kj <br /> This application is made in compinanc� <br /> compliance with County 0r di No. 549. ' f t <br /> ---------------------------- <br /> JOB ADDRESS ALOC -T <br /> n A - -----b,--------------------- ------- -• - ----- ----- <br /> T,0 <br /> tO <br /> ------------ --------- ---- --- _- --- ------- ------- Phone----------------------------0_0. <br /> Owner's 'Name n 1121IL4--- ----------------------------------------'---------- <br /> Address---------------- <br /> --- <br /> G e-2—�_ <br /> Address------------- llq_�w------------ ------------- <br /> (�- ---------------------------------- <br /> Contractor's Name----- <br /> 4--11--- ----- ---------- ------ -- -------- -------- wone----I <br /> Installation will serve: Residence Apartment House ECommercial ETrailer C0.u <br /> rt ------------------------------ <br /> El Motel Other [] <br /> Number of living units: T- Number of bedrooms -4-- Number of baths __J+�'Ldsize ------ ---------------- ------------ <br /> �'T <br /> Water Supply. Public system_ El Community system El Private V"Depth to Water table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel [] Sandy Loam M--clay Loam E] Play Ej Adobe C] Hardpan F] <br /> Previous Application Made: (If yes,date..---------r---------I No New Construction: Yes �o E] FHA/VA: Yes E] No [j <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fank'or cessipool.permitted if public sewer is available Within 200 feet.) <br /> Sepfic�Xank- Distance from nearest well___ Distance from-.foundation- ----Material--- <br /> -- ---------- -- ---- _________________ <br /> No. of co'm' partrnenfs---eR--------------- S -------- paci Y4 <br /> depth______41---- Ca ty <br /> DispospYlkeld: Distance from nearest well----4�.....Distance from foundat'on-1-Z ---- Distance to nearesf lot lines. <br /> Number of lines-- Length of each Iine__y4_r_e-41_�-eVAVidfh of trench---*-- ----------------------- <br /> Type of filter ......Depth..of filter'material--- -------Total length----/164�---------------------------- <br /> Seepage Pit: Distance to nearest well ---------------Distance from foundation------ --- <br /> --- ----------Distance to nearest lot line__-___________-_ 4. <br /> El Number of p;fs----------------------Lining mate`i­iaI__1­�_: ._.___-_---Size: Diameter_---------------------Depth--------------------- <br /> ------------- <br /> Cesspool: Distance from nearest well____„ -___- .--Distance from foundation------- Lining material-------------------------------------- <br /> r; 1-� I.- <br /> F1 Size: Diameter--------t-------- -------------------:Depth----------------------------------------------ti`----Liquid Capacity----------------------------gals. <br /> 1�1 . <br /> Privy: Distance from nearest well-------------------------------- - --------------Distance_f rom,nea resf,.b u-ilding--- -------------------------- ------- - . <br /> ❑ Distance to nearest lot line_________________________________ A------------------------I- ---------- ---------------------------------- <br /> 1 - - <br /> Remodeling and/or repairing (describe):---------------------------i <br /> ---------------- ------------ 4-`----------- ------------------------------------------ ------ ------ <br /> t <br /> ----------------------­---------------------------------------------------------------------------------------------------------------------------------- --------------------- ---------------------------------------- <br /> -------------------------------'_--------------_-••_----- --------------------------------------------------------------------------- ---------------•--------------------------------------------------- <br /> L - <br /> --------------------------------m------- I------------- ------------------------------------------ ------------------------------•---------------------------------------------------- -------- --------- <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 the San Joaquin Local Health District. <br /> Signed - --- --------- - <br /> - - - - - <br /> /or Contractor( By - ------ ------ ---- lTifle --- <br /> l <br /> (Plot plan, showing size of lot, location of.system in rela* ells, buildings, etc.,.can be placed on reverse side). <br /> FOR DEPARTMENT.-USE ONLY <br /> APPLICATIONACCEPTED BY ---- <br /> --------------------------------------------- DATE---CS-7Y--1-1__/------------------------------ <br /> REVIEWED BY---------------------------------- - ---- -------- <br /> ----------------------- ----------------------------------------- DATE------------- ----------------------------------------------- <br /> I, - I - -�� -.... -IDA <br /> BUILDING_PERIVIU�ISSt IED - -----­-------------------- ----------------------------------------- <br /> TE------------------------------------------------------------- <br /> Alterations and/or recommendations:__.__---- ---------------------I------ ------ -------- --------------------------------------------------- <br /> ------------------------------ <br /> ------------------------------------------------------------------------- ---------------------------------- -------------------------------­------------------I------------ ---------------------:------------------ <br /> ------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------- ------------------------------------------------------------- <br /> ----------- -------------------------------------------------------------------------------------------------- -----------I---------------------------- ---------------------------------------------------1-------------- <br /> ------------------------------------- ------I-----------------------------------:-------------------------------------------------------------------------- --------- --------- ----- ---- ------------------- <br /> FINAL INSPECTION ------------------------- Date-- ---- ~- - <br /> --- -- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3"63 F.F.CD. <br />