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F R OFFICE USE: <br /> --------- --- ���----- / <br /> _ c _________________._ APPLICATION FOR SANITATION PERMIT Permit No. ..;1 <br /> ,rte <br /> ----- --- - - -- - (Complete in Duplicate) �/ - <br /> 'j This Permit Expires 1 Year From Date Issued <br /> Date Issued _r-...,1 ..-�._ <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 ATION / ,,4e s?7------------------------------------------------------------•------------..------------------- <br /> Owner's NameX�, Phone.. <br /> •--• --- <br /> Address.............................tZ5 . 1 --- . ......... -- --------- --- ....................................................................... <br /> Contractor's <br /> -- <br /> Contractor's Name - ----- - ---------------------- Phone.................. <br /> Installation will serve: Residence [�'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 <br /> // �J <br /> Number of living units: ----L Number of bedrooms --.&_!Number of baths .1..... Lot size ......9_ ��r1�-�!_-------____--._.._ <br /> Water Supply: Public system a__60,mmunity system ❑ Private ❑ Depth to Water Table A. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [] San Loam ❑ Clay Loam E] Clay ❑ Adobe ardpan 11Previous Application Made: (If yes,date...-----.-----------) No New Construction: Yesto ❑ 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 T k: Distance from nearest well.... ------Distancgjrom foundation./_/--..Ma jal_ .C1� YL.G__af." ..-__..._..- <br /> No. of compartments---------7^-_ X_ 7.......Liquid 'epth------7,C ---------Capacity...._f 1 ..... <br /> ---------Size.-- -------- <br /> Disposal field: Distance from nearest well____��Distance from foundation....-........Distance to nearest lot line----. <br /> Number of lines....... _... ..... .................Length of each line...._7Z a. _ -- <br /> --- ------ of trench------s�?_,�,��`!--.-._.-._.. <br /> Type of filter material... ----------Depth of filter material_._.z Total length---------- _.�..................... <br /> See Pit: Distance to nearest well._.- '---------Distancefrom undation-2Q-.........Distance to nearest lot line--- ` J <br /> Number of pits-----i----------------Lining materiat_; c-�5ize: Diameter-3-Y--------- Depth_c .aS._.� zs. s' <br /> Cesspool: Distance from nearest well.................Distance from foundation._..----------.-----Lining material-------------------------------------- <br /> R Size: Diameter---------------------- ------Depth----------- --------------------------------------..Liquid Capacity_-----_-----------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ V <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------- ---------- <br /> Remodeling and/or repairing (describe):---- ' �GSi�/r 7G! •--•-•--- <br /> G <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------7_7_1 --------------------- <br /> -----------------------------•---------• -•------------------•-------------•-------------------------•----------------• -----------------------•-----•------------------------ <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 ws, and r s d egulations of the San Joaquin Local Health District. <br /> 6_�-- Owner and/or Contractor <br /> (Signed)------------o-- ----f ------------ <br /> BY: �y- ---------------------------------------(Title) G`�` - <br /> (Plot plan, showin iz of lotion of sy�in relati n o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- t---- -------- ------------------------------------------------------- PATE-•-- -6 - <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED...................................... DATE- <br /> Alterations and/or�ecommendati n�C f. � ,, 2 �:��:... =C: <br /> _.. .. --- <br /> - ' <br /> . ---- -- ... - . <br /> � 1" -----------------------------. :._��----------��----- ------�--------------------- <br /> FINAL INSPECTION BY:. C.:._. G -' Date h� `S --------------- ----- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton 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 S-S9 3M 3-'63 F.P.DD. <br />