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FOR OFFICE USE: <br /> ------------------------------------------------------ -- <br /> ----------------------------------:------_-------------- APPLICATION FOR- SANITATION PERMIT Permit No. <br /> -------------- --------------- (Complete-in Duplicate) <br /> -7. 240te Issued <br /> ......... ............................... This Permit Expiras I Year From Date Issued 0 - <br /> Application is hereby made to the San Joaquin Local Health District fora permit to consfruct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. t <br /> JOB ADDRESS AND LOCATION-a?--- - ------&_-o- <br /> Owner's Name 65----,-- e-A,64-641/-------------- Phone------------------------------------ <br /> 7 <br /> ­A 1 7- , 0 , I - -------------------- <br /> Address---- 4/ <br /> ------- ----- ----------- <br /> Contractor's Name-------- --- ------ -------------- _/--------------------- ---------.-- Phone------ --------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial E]c3 HTra�ilerourt E] Motel 0 Other E] <br /> Number of living units: _/----- Number of bedrooms-.3--- Number o is--------- Lot size ----I'le --- - <br /> - ------- -- --------------------------- <br /> Water Supply: Public system El Community system E] Private Derth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam E] Clay Loam 0 Clay �Adobe [:] Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No El New Construction: Yes E] No E] FHA/VA: Yes [I No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> '5 0 / istance from foundation......". <br /> Septic �dk- Distance from nearest well-----' - - D ------ -------Material ---------- ------ -- ----------------- <br /> mo. <br /> E? No. of compartments------,-- Liquid depth------//-. Capacity-/An_oA.7---- <br /> Dispo Field: Distance from nearest -----Distance from founclation_AA........._Distance to nearest lot lin&S"l------ <br /> Number of lines.------------7�-------------------Length of each line-- .---./-0--6...............Width of trench. -�-?_r"__;1; ------------------- <br /> Type of filter maferia}--------oo-12.......Depth of filter material----../—f"­_-Total length_---_. ------------------------ <br /> 'See p I Pit: Distance to nearest well...... Distance from foundation.-_- ---- Distance to nearest lot line... ..6�---------- <br /> Number of pits--------- Lining material.---!FF 1Z.r------ Size: Depth....ys <br /> - ------------------ <br /> Cesspool: Distance from nearest well ..._-_--____-Distance from foundation Lining material__._...-____-.-----_--.--_____-_---.Size: Diameter- -- -------------- - -------. ---Depth- .-- ------------------------ ---------------------Uquid Capacity----------------------------gals. <br /> Privy: Distance from nearest welf---- ---------------------- .......... .. Distance from nearest building-__---..______.__...__._____.._...__.-. <br /> ❑ Distance <br /> uilding-_-------------------------------------- <br /> Distance to nearest lot line --------- ----------------------- ---------------------------------- <br /> Remodelingand/or repairing (describe}:---- ................. --------------------------------------------------------------------------------------------------------------------------------- % <br /> ---------------------------------------------------------- --------------------- ------------------------------------------------------------------------------------------------------------------------------------------ <br /> -----------------------------------------------------------------------------------------------------r----------------------------------------------------------------------------------------------- - --------------- <br /> -----(------------------------------------------------------------------------------------- ------------------------------------ <br /> ---------I' _h_ere­6y---certify-6--at-) have prepared---this---a-p---pli-c'-a-tiori and that the work will be done in accordance with San Joaquin County <br /> ordinances,.St ate laws, d rules and regulations of'fhe San Joaquin Local Health District. <br /> (Signed)--------- ---------- -- ---------- ....... -------jel............. ------------- --------I---------- ---------_ ­.IQVMft_and/or Contractor) <br /> By:-------------- ......... .. ..... .... ..1-1- ------ ---- -------------------------------------(Title)---------- -- - ------ ------------- <br /> ,a; m = <br /> N <br /> (Plot plan, showing size,of lot, location o system)n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ....... <br /> REVIEWEDBY--------------------------- -------- -- ------------------------------------------------------------------------ DATE <br /> BUILDINGPERMIT ISSUED-------- ----------------------------- -------------------------------------------------------------- DATE---- ----------- ---------------------------------------- -- <br /> Alterations and/or recommendations: <br /> _--- - --- - ----------------------------- -----------I--------------------------------- -- --------------------------- --------------------- <br /> ------------------------------------------------------ ------ ------- ----------------------------------- ----------------------------------- ----- -------------------------------------------- --------------•-•--------- <br /> S ---------- ------ --------------- ---------- --------------------..------------------------------------------------------------------------------------------------------ ------- ------------------------------------------- <br /> ---- ---------------------------------------------- --------------- --- ...... ----------------------------------------------------------- ------------------------ -------------------------------- <br /> ------------------------------------------- - ---------------- --------------------------------------- ----------------------------- ------ ------------------------------------- <br /> FINAL INSPECTION BY: ate- -O-- ;z-6 i�'7 <br /> - --------------- ----- D / - - ------------------------------- ---- ------- - <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 /> F.H.9 2M 1-67 Vanguard Press <br />