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FOR OFFICE USE: <br /> ---------- <br /> - ----- ` ------- -------- ------ <br /> �. <br /> _:°...... ................... - APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------- ---- Com lets-in Duplicate) <br /> t � ----- --- ------- ------ -- _ _ � P P• � . Date Issued --------------�---- <br /> .. - .:...........:..... ___':__._._' This-Permit Expires 1 Year From Date Issued 2-'65— 0&0 -34 <br /> I <br /> Application is herebymade 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 />' 7 "Z7 <br /> JOB ADDRESS AND L TION �_/C. ./ l _ . ------ <br /> Owner's Name--------- --•-_4A_--"__7_JA------ - Y Y x ----------------------- hone-S. 7rf� <br /> Address ----P° <br /> - ------ ----------- <br /> f '�1 f i t <br /> c" a ,Contractor's Name }�. �-�.�F-X_ �_ 1' ---------- Phone <br /> O <br /> A /7---- <br /> ion will will serve: Residence ❑` Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> =:. / <br /> units: -0... Number of bedrooms -` Number of baths--.-___ Lot size <br /> r Number of living --- ---- -- - ------ ----------------- � <br /> .; Water Supply. Public system ❑ Community system ❑ Private[g-Depth to WatJ'TebleS ft <br /> � <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay [] Adobe ❑ Hardpa4�C] <br /> Previous Application Made: {If yes,date_ ' -.- , .--.. } No 5Z- New Construction: Yes ❑ No`K FHA/VA: Yes ❑ N'k - -. -TYPE OF INSTALLATION AND SPECIFICATlON5:septic tank--or=cesspool permitted if-public sewer is available-withU7100 feet:}� <br /> Septic Tank: Distance from nearest well----------- <br /> Distance from foundation--------------------Material..._-_-_-__..-..-.,------_-_.-._-.._-_____-_---. <br /> No, of compartments_................:. !-Size___---_-----:. <br /> S<xS�iit7G } ------ -I--- -----------Liquid depth--------- ------ Capacity----------------------- 4 , <br /> r <br /> Disposal Field: Distance from nearest weEf_ _Distance from foundation___--__-_..........Distance to nearest lot line______...__-_____ <br /> ❑ Number of lines--------I------------------------ Length of each line--..------------------------..Width of trench---------------•------------------ <br /> Type of filter materiel--------------- Depth of filter material_- --.--_--- --__-_-Total length--____---_-_------._---- -__----_.----.__t Or <br /> P <br /> Seepage Pit: Distance to nearest~ eii_. ----------Distanc rom undation---_ ....._._.D st nF� to nearest t line-41.01-W. ---- <br /> Number of pits.. . --------- material- -__ Size: Diameter.- ------------Dept�l_ _ T____--_ <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 /> ❑ Distance to nearest lot line ----- ------ -------------- <br /> Remodeling <br /> ------- --Remodeling and/or repairing (describe)-'--- `--�--- •--------------- - -•----- -- -- ------- ----------------------------------------•-------- <br /> t <br /> -----•------•---•---------------------------------- - ------- ------- -- -------- - ----------- --- ----------------------------- ••------------------------ <br /> ------ ------ - <br /> ------------------------------------------------------------SSS- ----------- Z 0 <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, an d regulations of the San Joaquin Local � ealth District. <br /> (Signed) _-______-._..G _. __.1` _.._ -. -- -- �l® /�P.� _...(Owner and/or Contractor <br /> g I <br /> --- Tr Title . .. �(Plot plan,plan, showing size of lot, location of system in relation to Is buildings, etc., can be place on reverse side). .Q <br /> ' FOR DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- <br /> ~-- �~ ��------- �- ---- ---�------------ ---------- -------- ----- DATE------ <br /> REVIEWEDBY------------------------------------- ---------- --- --------------------------------- ------- --------------- --- --------- DATE <br /> ------------------------------------------- <br /> i BUILDING PERMIT ISSUED.------- -- ----- ---------------------------------------------------- ----------- ------------ -- DATE----------- <br /> - <br />° Alterations and/or recommendations:.................._._._._ ' <br /> ----------------------------------------------------------------------- -------------------------------------------------------------- ------- --------------------------------- <br /> ------------- -----. - ...--.----. --- -- -{ ---� --------_-. _. ----- ------------------------------------- <br /> ---- -- -- ----------------- <br /> ---------------- - f <br /> FINAL INSPECT"*- fly<�� . ---- Date........../ ------ GL-�F-------------------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h street <br /> Stockton,California • Lodi. California Manteca,California <br /> Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />