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FOR OFFICE USE:/ <br /> tk <br /> .. .. .. . <br /> APPLICATION FOR SANITATION PERMIT Permit No. ............. <br /> ------------------ -- -------------- <br /> --------- --- 0 7' <br /> ----- --------------------------------------------------- I I (Complete in Duplicate) Date Issued t- <br /> ................;.j This Permit Expires 1 Year From Date Issued <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 /> JOBADDRESS AND ............... ...................................................................................................... <br /> Phone.. = -------------------------- <br /> ------- -------- ---------------------------------------- <br /> _----_-_-------------------- <br /> Owner's Name...... ........... <br /> Address ,3 )_3 ---------4, <br /> ............._....... ...... gu-1-------------............. --------'----- ----------------.................................................. <br /> _S1 -T_? .......... Phone--------------------------------z.- <br /> Contractor's Name__.-- --------- ...........­-­.. V <br /> Installation will serve: Residence [Apartment House El Commercial C] Trailer Court [3 Motel 0 Other -0 <br /> Number of living units: ---I---- Number of bedrooms -__L Number of baths ___Z____ Lot size ..................:----•-------- <br /> Water Supply. Public system irl-c-ommunity system El Private [] Depth to Water Table��_ ft. <br /> Character of sail to a depth of 3 feet: Sand [:] Gravel,0 Sandy Loam 0 Clay Loam [3 Clay (3 Adobe Et"Hardpan 0 <br /> t I-, q— <br /> Previous Application Made: (if yes date__________________.) <br /> No,V1 New Construction- Yes Erq—o E] FHA/VA. Yes [3 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool,permitted if public sewer is available within 200 feet.) <br /> Se t-- Tank- Distance from,[nearest well_________________Distance from foundation------------_-----Material----------------_............................... <br /> pa No. of compart'menfs--------------------------Size----- ---------------------Liquid depth-- ............. ---------Capacity................. <br /> - <br /> Disp al Fiel Distance from'nearest well______________-_Distance from foundation----_-------------Distance to nearest lot line_____..........._C <br /> Number of linas-----------------------------------Length of each line-----------------------------Width of trench----------------------------- <br /> Type of filter Aaterial.--------------------------7-Depth of filter material------------------_--Total length----------_---------. ------ <br /> .� <br /> Seepaget: Distance to nearest well_174_ -______--Distance from founclafion--A...,----------Distance to nearest lot line_ <br /> Depth <br /> Number of pits____. jr!2---------Lining material__ -------Size: Diam ater-------36........... --- --------------- <br /> - <br /> r <br /> Cesspool:: Distance fromnearest walLggftes�......Distance,from founclation-7tr--------------Un ing material_..11--- ------------------- <br /> Size: Diameter-:-------------------------------------Depth----------------------------------------------------Liquid Capacity;,,--------------------------gals. <br /> 171 .I , ;;-,- <br /> Privy: Distance froryi nearest well---------------------------------------___....Distance from nearest building---- .........................❑ .. . <br /> 9 1line-------------------------- -Y--- ----------- <br /> Distance to nearest lot ------------- --------­-------------------­1--------------------------------------------------- <br /> ............ <br /> Remodeling and/or repairing (des[ribe):---------------------------------------------------------------------- _---------------- ------------------------------------- ----------- <br /> -----­----------------­----I---------------- ................--­-----------------------------------------­1------------------------------------------------------------------------------------••--------- <br /> --------------- <br /> --------------------I--------- <br /> --------------­ -------------------------••--------------f---.--.---.-----------•-------•--------------------•-•---------------- ....I-----------------I----------------------------------- ---------------------------­- <br /> ----------------------•-•-- -------------------•I-------- -------- ----------------------------------- --------------------------------------------------------------------------------------- <br /> I hereby certify that I have Plv6pared s a plication and that the work will be done in accordance with Son Joaquin County <br /> ordinances, State laws, and rule1,s'iand reg do of the San Joaquin Local Health District. <br /> _21 <br /> ---------•--•(Owner and/or Contractor] <br /> (Signed)------------------------------------------- --------- -- - ---- -- -------------------------------------------- ------------------------ <br /> BY:---------------------....... ..... .....-------------------------------------------------------(rp+le)--------- ---------------------------------- - ----------------- <br /> .......... .... ........ <br /> (Plot plan, showing size of I t, afion of system i relation to wells, buildings, etc., can be placed on reverse side). <br /> FO DEPARTMENT <br /> U" ONLY <br /> ---------------- <br /> APPLICATION ACCEPTED BY-.--- ..... . .. -- ------ .... ------- ---------- <br /> . . ................... ............ ...... <br /> REVIEWED BY-------------------_----_-- ----------------------------------------------------------------- ----------------------------- DATE. ......----------------- <br /> _ 1 ...... DATE.. ---------------------------------- <br /> BUILDING PERMIT ISSUED........ ------------ <br /> --------------- -* <br /> Alterationsand/or recommendations-------------------------------------------------------------------- ------------------------------------------------------------------ ----------------------- <br /> •------------•-•--------------------•---••---•----1-----•----------------- -------------I-----------------------------------------------------------------­_­..................................... ...... <br /> ­­------------------------------------------------I---------------- -------------------------------------------------- --------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------I...... ------------------------- ­----------------- -----------------------------------------------------I——-------------------------------------------------- <br /> ----------------------- --- - ----------------------I------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ <br /> -------- ....... <br /> FINAL INSPECTION D - - ----- ------ ------ — <br /> HEALTH DlSTR C &-- -------------------------­---- <br /> SAN JOAQUIN LOCAL Hato_/ <br /> I <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California j <br /> ES 9 REVISED U-59 2M 5-61 ATLAS <br />