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FOR OFFICE USE: <br />--------------------- ----- ---- - <br /> ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---- (Complete in Duplicate) - v-fO v <br /> _11-0._._.-.--- This Permit Expires 1 Year From Date Issued Date Issued _. .._.._3.._..__. <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 4Z/2 <br /> County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------.4 �-2........ S S' .......&-------��-----------------------------------•--•----------.................................... <br /> Owner's Name ` ' �f -- - 5------------------------------------------------------------------------•--- Phone .4.51 .._. <br /> Address................... '� ��GaS ---------•-------/----•---- ------•--------------------•--•----------•----------------•------------••---------• ------.......--•-------•- <br /> 56�� ` � f7� v�----------------------------•-------- Phone-A ..9Z.A <br /> Contractors Name_________________________ _ .__._._.. __ �`1 <br /> Installation will serve: Residence 1A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j___- Number of bedrooms .Number of baths ,1... Lot size -_.. ' $. ............... <br /> Water Supply: Public system' Community system [71 Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam ❑ Clay 11Adob Hardpan ❑ <br /> Previous Application Made: (If yes,date--_.--.-_-----.---) No ❑ New Construction: Yes ❑ No O�,FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> o septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> is Ta Distance from nearest well-----------------Distance from foundation....................Material---_----______-----_-_:.;-__--------..---_-_----. <br /> No. of compartments---------- ---------------Size----------------------------=---Liquid depth-------------------------.Capacity............ <br /> 0--........ <br /> "q ,45 <br /> Distance from nearest well_ Q._.^._Distance from foundation..... t_� ._.Distance to nearest lot line.....<a.._..... <br /> Number of lines------_�--- --------------------Length of each line-----6__0.------------.Width of trench....•.a,`z�!�------------- <br /> 4- , Type of filter material_: -a.._..__Depth,of filter material_.__./,P-/ -_...Total length........._ _Q.'..................... <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. \ <br /> ❑ Number of pits______________________Lining material...... ------.---------Size: Diameter-------------------_...Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation......--------------Lining material..................................... <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gal <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F1 <br /> ._____-___-- -----•--__-__.--_----.❑ Distance to nearest lot line------------ ------------------------•----------------------------•-------------------•-----------••-------------------•--•---------------- <br /> Remodeling and/or repairing (describe--------------- ---------------------- ------••-------------- ---------------- �� - <br /> r <br /> .............................................................• ....... --- --•----------------- ..•---.........-- <br /> ----------•----------•---------------------------------- ---------------------------•--------•-----•--------------•------------•------- --------------------------------------------•--------------------------- <br /> I hereby certify th have prepared this application and that the work wil be done in accordance with San Joaquin County <br /> ordinances, State laws rules and regulations of the San Joaquin Local Health District. <br /> (Signed) """y ------------------ ----------- ------ ------------------------------------------------------ r Contractor) <br /> By:.2905E.-1�uim►earAVP—_40L 2-7046 --------------- ---------------------•----(Title)------------------------------------------------ -------------- <br /> (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------- ---=-- �-- DATE S. ` ©=�P <br /> REVIEWEDBY----------------------------------------------- -------- DATE------------------------------------------------------------ <br /> BUILDBUILDING <br /> ING PERMIT ISSUED..............................................................--------------------------------------- DATE <br /> and/or recommendations:-----------------------------------............................................................................................................................ <br />_. ------•-----------------------------------........................................................................................................................................................................--------- <br /> ----------------------------------------------------------------- ----------------------------------------------------------------------------------------------------•-••--•----•--•-----.................................. <br /> ------------------------------------ -----------------•---------------------------------------- ----------...................................................................------------------------------------•....... �l 1 <br /> ------------------------------------------------ ------ -----------------------------------•--•-•-----------••------•-••--------------•-------•---••-•-------............................................................ <br /> -- Date------•--- ---•--•------------------ <br /> FINAL INSPECTION BY------ -- ----- - -- - - ---- •-------- `�`-=--�-r--=-rli-�,-------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 REVISED 6.59 r.P.DD.2M 6-60 <br />