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j,tIQFFICE USE, <br /> ----------------- <br /> - <br /> APPLICATION FOR�SANITATION PERMIT Permit No. <br /> c------------------ ---------...... <br /> --------- -----------------/_ ------------- (Complete in Duplicate) <br /> -------------------------- ..N This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the workherein d scribed.` 0 <br /> This application is made,in,compliance with County Ordinance No. S49, <br /> -------- ------------------- <br /> T- ------- -- -- -------- <br /> JOB ADDRESS AND LOCATION ----------6-&:A----- ----------- , 1 .9 - __ <br /> -- ------- i-- -------- <br /> Owner's Name_______ --------- Iff-&-&------------------ hone. .14.3-110-ry <br /> ------------------ <br /> Address---------------------- -------------------------------------------------------------------- <br /> Contractor's Name----------- J� , �(.,0'.7 <br /> ------------------------------------------------------------------------------ Phone-------------------------------- <br /> Installation will serve: Residenced Apartment House E] Commercial [] Trailer,.Court E] Motel E] Other E] <br /> Number of living units: _1---- Number of bedrooms J^-�Numb6r of baths ___I___ Lot size e5t_ZA-_�_ ------------------------ <br /> Water Supply: Public-system '[] Community system El PrivateDepth to'Water Table -&-_ ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sand�Llam E']-Clay-Loam []j Clay E] Adc,b� Hai­clpa, ❑ <br /> Previous Application Made: (If yes,date_..______-._.._.__) No New Construction: Yes [] Not FHA/VA: Yes E] ,N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: k <br /> t(No septic tank or cesspool permitted if public sewer is available-within 200 feet.) <br /> Septic at�- Distance from nearest well.-----------------Distance from foun dot Material--------- --------------------------------------- <br /> No. of compartments�------------------------Size--------------------------------Liquid depth---------------I-------- <br /> capacity--_------------------- <br /> Disposa Fi.el Dista4c6­fromne ... I e to nearest lot <br /> Nunil�e' r of lines <br /> aresf well _��,r_,-_.D'sfance from founclafion.._6P----- Distanc line---- ------ <br /> -------------- -/V -- -------Length of each line--------CS.............Width of trench------ ----------- <br /> T__ <br /> Type of filter materia of filter material-----___-&!---Total length---- ex:ft ------------ (0 <br /> See 11 P, Distance to nearest well---IC-r- -______Distance from foundation------7,0_Distance to nearest lot line--.-'----5--------- <br /> Number of pits------- ---------Lining mate ria Diamefer_7!-_!-_33..'___Depth------ --- 1r-__ <br /> Number <br /> -Distance from nearest well-----------------Distance from founclaf ion--------------------Lining Material--------- ---------------------------- <br /> F-1 S;Ze: Diameter--------------------------------------De pth-----I--------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---.,- ----:------ :,---- -•_-----.--__Distance from nearest building-.,. <br /> =:_____ --- ---- <br /> F1 Distance to nearest lot line--------- -------------- ------------------------------------------------------------ ------------------------------ <br /> Rerno'deling and/or repairing (describe):------- —'e"�- e- A. ------------ -&---- -------------------------------- <br /> --------------------------------------------------------------7-------------------------------------------- ----------------------------------------I----------------------------------- ------------------- <br /> ---------------------------------------------------------•----•-------------•---------------------------------------------------------------------------------------------------------------------------------------------- <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 /> -------------------------------------------------------------- . - ---------------------- <br /> ordinances, Stat aws, and rules and regulaflons'of the-San Joaquin Local Health District. <br /> (Signed} ---------------------------------------------------------- --------(0y'ner and/or Contractor) <br /> By:-------- ---- Le. -------------------------------------I-------------- --- -------------------------- <br /> Xt,�. _' <br /> (Plot plan, showing size of lot, location 4'system in.relation to wells.' buildings, etc.,•can.be,placed.on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 7 BY-----/- --------------- _ ------C7_____f -- -------------------------------------- DATE------ <br /> - 1__/---- ------------------- <br /> 4 - <br /> --------------------------------------------------------------- DATE-------------------- <br /> REVIEWED BY----------------------------------------------------------; f <br /> BUILDING PERMIT ISSUED------------- - - - - -----------------:-------------------------------------------- DATE-----------I---------------- ------------------------------ <br /> Alterations and/or recstrinmenclaflon's':-------------(�� 7,4 <br /> 4- <br /> ........... <br /> -------------- -------- ez3-------------------------------------------- ---------------------------1------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------------- ----- --------------------------------------------------------I--------T <br /> -------- ------------------ -- ---------------------------------------------------------------------------------------- ------1------------------------------------------------ -------------------------- <br /> - --------- -- ------------­----------------------------------------------------------------------- -------------- -------------------- ----:----- jY <br /> ------------------ ------------------------------------- <br /> d <br /> V <br /> e <br /> FINALINSPECTION BY---------------/( -------------- -------- •- -------------- Date-------------------,(.----.---------------------"X - ----------------------- <br /> SAN <br /> ---------------- <br /> S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street )24 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 31A 3`63 F.P.Q0. <br />