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FOR OFF�CE)05E: 'I ✓ # <br /> x 6~_ l_ ,, 5 <br /> -__--.- -___-- ._ �-. -".-....---elhi APPLICATION FOR SANITATION PERMIT Perinit(Complete in Duplicate) r/ <br /> ,l ......- 1;47 �Z_- <br /> --------------- -------------------------------___.____._ _1M This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health Di ict for a permit to construct and install th rk herein described. <br /> This application is made in comp' nce with C unty dinan o. <br /> P <br /> JOB ADDRESS AND N °`+ �'` .... <br /> ................. <br /> Q <br /> Z. <br /> Owner's Name { .: ----•-- --•-•------••------ Phonti� <br /> Address--------------- <br /> ---- --- -------------------­-------------------- <br /> Contractor's Name------ �_,�_ c_ !... � '�3. Pho <br /> Installation will serve: Residence 2� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑� ee <br /> Number of living units� ._,�_. Number of bedrooms Number of baths /. Lot size .. 419.- .......... <br /> _..�_s .................... <br /> Water Supply: Public system,-Community system ❑ Private [I Depth to Water Table �--- ft. T <br /> Character of soil to a depth off 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay C] Adobeg Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------- ----) No E] New Construction: Yes E] NoX FHA/VA: Yes ❑ No ❑ <br /> ,I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cess <br /> ,,i.pool permitted if public sewer is available within 200 feet.) <br /> S c T . - Distance from nearest well-----------------Distance from foundation------------------_Material____.______________-_•_---_.-_-_------------•---- <br /> No. of compartments--------------------------Size_---__--..---------------- ---Liquid��ydeRth--------------------------Capacity--••---------------f-- <br /> os lel Distance from nearest welL _ r.._.Distance from foundation___Q_�_________.Distance to nearest lot line___ ____. <br /> Number of lines_._......__- Length of each line_____..- Width of trench._ r_ _ `............... <br /> Type of filter materia._. _,_ Depth of filter material____-_ ---••__Total length....... <br /> e ag i Distance to nearest well_�.-._.z,4'_____Distance from foundation__-----------..Distance to nearest lot line__-_ ..._ <br /> ddNumber of pits...._---------------Lining material__ -P. __-_Size: Diameter___ ___-Depth---- ............. <br /> cesspool: Distance"from nearest well--- _ <br /> --------------Distance from foundation material____________•___--_-___-_.-___ _._-_ <br /> El Size: Diameter--------------------- ----De th-------------------•- -----------------------------Liquid Capacity___. gals. <br /> Privy: Distance from nearest well _-----------------------------------------------Distance from nearest building___________---_----.-..-_-.___._______- <br /> ❑ Distance to nearest lot line----------------------------------------------- ---------------------------------•------------------------------------------------•--•-------- <br /> IN,: <br /> I Remodeling and/or repairing (describe)________________________ <br /> ------------------ ----------- --•••-------•-•-- ------------------------------------------------------------ <br /> •---------• ...... -• -•-------------- - -------------- <br />! ----------------------------------------------------•-•------------ - - ---------- -- . --------------...---- --- --- -- - ---------------------- <br /> 91Z <br /> ------------.-- ---- .. ;. <br /> -----------------------------•------ ------•-•-I---------•--------------------------------- -------------------------------- ---------------------------------------- -------------.....------•--------------- <br /> hereby certify that I h"ve prepared this application and that the work wi be done in accordance with San Joaquin County <br /> ordinances, State law , and rles and regulations of the San Joaquin Local Health District, <br /> 9 77 <br /> f -------- <br /> (Signed ` _) � . Contractor) <br /> Title <br /> BY- -1 -- <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildings, c., can be placed on reverse side). <br /> .I <br /> FOR DEPARTMENT USE ONLY <br /> ,IF <br /> Fpp <br /> APPLICATION ACCEPTED BY > F ---------------- --------------------------- DATE-..._ 1 �..� �— <br /> REVIEWEDBY------------- ---•----J1= . .-. _... . ...- ------ DATE------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-11----------------------------------------------------------------------------------_---.......... DATE............................................................. <br /> Alterations a nAtor <br /> -r.e om r9enc a. tions:--------- -------------------------------- -----------------------...� �.. -----..--„�- .--------•-----------•------- <br /> ----------- -- <br /> ........................•-.------------..... =.----• ••- - _....:.. ------•-----.-----------------------••---•----------------- •-.----.-------------------•----------------------------------•---•-----••-•-------- <br /> �I, ----------------------------•------------•---------------------------..------- •------ <br /> FINAL INSPECTION BY:..' r --------------- Date--- .1 r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut 300 Weil Oak Street 124 Sycamore Street 205 Wert 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES REVISE0 6-B9 9M 5-61 Art.A9 <br />