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7 OR OFFICE USf " °p /,('�j��]��\/�r'�� (/�/'I� <br /> aok <br /> CATION`-FOR SANITATION PERMIT Permit No. . l_..... ...... <br /> _______f(�____ (Complete in Duplicate) <br /> y <br /> -- Date Issued ------ <br /> 4"y <br /> __•S`.____ _ _'_ _ . This Permit Expires 1 Year From Date Issued <br /> ---- ------- <br /> -- --- <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 /> JOBADDRESS AND LOCATION = - ------ -------------------------------------------------------------------------------------------------•------------ <br /> �Z ` ` Z---------- f <br /> Owner's Name , .— ✓ �`? Phone - <br /> Address-----•---- � <br /> Contractor's Name ----------------------------------- <br /> . ,---------------------------------------••--------------------------------------------------- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ./___ Number of bedrooms _Z Number of baths ___L Lot size ................. <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ---:T ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er-Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No 2" New Construction: Yes ®/No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.���� ance from foundation---/.C-�_____-.Mater l_f�=---------------------­--i ..._.�,� <br /> [�/� No. of compartments-_______•_"_____.__Size._:: X �__X__�_._Liquid depth......Lf' ----------Capacity t' , _ <br /> f <br /> Disposal "Field: Distance from nearest well/l stance from foundation••%.C'---------Distance to nearest lot)ine------Z....._.. <br /> Number of lines-------�7----------__________Length of each IineZ.�. :..-,___-- Width of trench._____�-_,--------------------- <br /> Type of filter material..,k_c_'0_{C.._'----Depth of filter material------!_ ---------.Total length___--_�_e....................7.... , <br /> See pa Pit: Distance to nearest well_ ' Distance from foundation...../ ........Distance to nearest lot line :�_...... w <br /> Number of pits_______,(________Lining material___ _cj�4___Size: Diameter__ _. -------1-Depth_____ e-----1-Z. 6 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining Material-------------------------------------- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> 171 Distance to nearest lot line-------------------------------------------------------------•-------------•----•--------------------------------------------------•-------- c <br /> � C <br /> Remodeling.mld/or repairing (describe):__ ��----` v� f s- tet -�. —......................... <br /> t—� �>� o--- <br /> —c? <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 r les an gulations of the San Joaquin Local Health District. <br /> n d - �- - -------------(Owner and/or Contractor) <br /> (Sig ------- - <br /> By:----•----- ------------------------------------------------------------------- ---------------------------------------------------(Title)--------- ----------------------------------------- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- -� '� <br /> ---- - - -----�'-'--1-3...-----------------------------_._ DATE-----------� -------f-------�---'------------------ <br /> REVIEWEDBY------------------------------------ -------------------- ------------------------------- DATE <br /> BUILDINGPERMIT ISSUED------------ } ------ ----- --------------•------------- DATE•------------- •-- -------_-------------------- <br /> IAlterations and/or recommendations:.. _ _ _ ________,P`` v _ o.L_cf_.__ --t__.._ t__,._.. <br /> ��- c ^� :L <br /> 6 , <br /> ------------------('� �` --------- <br /> ------------------------- <br /> `_° ---------------L-- ``' -- -----.• �` � ----------------------------------------------------------- <br /> ------ <br /> FINAL INSPECTION BY:_." -y-��-------- -- Date.. � ------------------------------- <br /> r3OOWest <br /> OAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 99 9 REVISED 8-59 3M 3-'63 F.P.DD. r' <br />