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FOR OFFICE USE: <br /> ' . -. f -- -- _- Permit No. . 7•......� <br />------------------ --- <br /> APPLICATI4N�'F4R"SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued <br /> --- This Permit Ex ares l 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 /> P <br /> This application is made in compliance with County Ordinance No. 549. <br /> - ---•------------------------ --------- ---------------------------------•- <br /> JOB ADDRESS AND LO ATI N......1770--------- <br /> � •--.•• --- ---- --- --- ------------ ------------- Phone-#®72 Z�.....+?P <br /> Owner's Name-----I ��� ----•---------------•-------------------•-----...-•----- <br /> AddressI ---- ---- --- ---------------•------------------------------------------------•------.-.-. <br /> Phone-------------------------•--------- <br /> ------------------------------------------------------- <br /> Contractor's Name------- • •---=--------- -------•---------- <br /> Installation will serve: Residence partment Hause ❑ Commercial ❑ Trailer Court C1 motel ❑ Other [I <br /> Number of living units: -.-U. Number of bedrooms <br /> J_ Number of baths , Lot size <br /> Water Supply: Public system M-Ir-ommuriity system ❑ Private [I Depth To Water Table _._eft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel El Son Loam C1 Clay Loam ❑ lay El Adobe' Hardpan ❑ <br /> Application Made: (If yes,date--------------- ----) No L� New Construct <br /> ion: Yes No ❑ FHA/VA: Yes E] No <br /> Previouspp I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Material -------•------------------•------ <br /> Sept Tonle. Distance from nearest well--------------_-Distance from foundation.___-..._- _______. Capacity <br /> �� r Size---------------------------------Li uid depth------ -------------- ----------------+----- <br /> No. of compartments-------------------------- q � <br /> Disposal d: Distance from nearest well.ohi .-.Distance from foundation-- -------------Distance to nearest lot line... ........... <br /> 4 <br />` Number of lines-:-----,---------•--------------Length of each line..-- ----------Width of trench.---_--.__ ..____.--------__-••• <br /> Type of filter materia._. La-i_� ----Depth of filter material. ---+-__-_-._Total length-------- - --�...------•---- <br /> I <br /> Sespage it: Distance fio nearest well_' "i^�__--Distance from foundation___ ___________.Distankce to nearest lot lin -_- <br /> - ---------- <br /> Number of pits11t --Size: Diameter----33Depth - ..Liningmaera--_ [ ? <br /> I <br /> Cesspool: Distance from nearest well------ <br /> -----------Distance from foundation--------------------Lining materia-.-------_--------• -------- al <br /> Size: Diameter- I------------------------- ------•-Depth--------------------- -----------------------------Liquid Capacity---_-----.-.---------------g e. <br /> ElSize: <br /> from nearest arest well-------------------------------------------------Distance from nearest building.----------------------------------------- �- <br /> ❑ Distance to nearest lot line-------- ----------- ----- --------:-•-----------•------- •------------ - <br /> 1 <br /> ---------------------------------------- <br /> Remodeling;.and/or repairing (desc�ibe):---------________.._-------------------------------------------------------------------------- <br /> ---_-••----------------- <br /> i _----------------------------------- <br /> ------------------ - <br /> - -- ---------•-------.--_------------------•-----------•-----••----•------------•----------•----•-------------•------------ <br /> ty <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin oun <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> k <br /> � --------------------------------------(Owner and/or Contractor) <br /> (Signed)-----------••---------------------•------ <br /> -- ----------- <br /> ! -- ---------- ------------------ -----(rtle] <br /> $Y:------------•----------------------•------ --------- <br /> (Plot pian, showing size of lot, location o system n relation t weiis, buildings, etc., can be placed:on reverse side]. <br /> i - FOR DEPARTMENT USE ONLY q <br /> R --------------------------------- DATE------! —� - ------------ -- <br /> APPLICATION ACCEPTED BY---------- - --- -_-- <br /> REVIEWED BY <br /> ------------•--------- DATE---•--------------------------------------------------••---- <br /> BUILDING PERMIT ISSUED----------_-�.. - DATE <br /> Alterations and/or recommend'ations:.-1_I_r� --- 3 <br /> ----------­----------- <br /> --------- - <br /> -------------•-------------------------------.."--.-- --•-- ---.. <br /> FINAL INSPECTION BY: _.. --:.c��. - --°- <br /> Date----------- 7 --- ----------------------------•--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> 300 West Oak Street 124 Sycamore Street 205 west 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> ES 9 REVI5ED 8-59 2M 5-6i: ATLA5 <br />