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—- - I <br /> F(?R OFFICE USE: <br /> --- ------- ---- ----- --- ------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br />-------------------------------- ------------------------ <br /> ---------- This PermitrEXP'reS 1 Year From Date Issued <br /> Application is hereby rnacle to the San Joaquin Local Health District for a permit to construct and inst l he work herein described. <br /> This application made in compliance with ;ounty Ordinance No. 549. <br /> JOB ADDRESS AN LOC'ATION.' ------a,- <br /> ----------- -----e_e,04---- _(- -----—- ----- <br /> '0 �__-1 e. <br /> V ------------------ ----- Phone.Owner's Name-- ...... --g."'t----------------------- -------------------------- ------------- <br /> -------------------------------------------------------------------------- - <br /> Address-----------_&A ---------------- <br /> -------- Phone------------------------------- <br /> --- ---------- <br /> Contractor's Name----- ------- <br /> Commercial E] Trailer Court 0 Motel El Other 0 <br /> Installation will serve: _'7Resi�ideceAp:,rtment House ❑ <br /> �k ------------ <br /> Number of living units: ---L Number of bedrooms ----- Number baths __/--- Lot"size <br /> Water Supply: Public system F1 Community system El Private Number <br /> th t Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: .Sand E] Gravel n Sandy Loam Clay Loam [] Clay E] Adobe [] Hardpan C] <br /> Previous Application Made: (if yes,date--------------------) No n New Construction yes [] No E] FHA/VA: Yes El No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> sf well_- ' ____ 11 -------- --------------- ------- <br /> Distance from neare ;OZ-Distancl from foundalion----- ......r ---- -------- <br /> SepWa/nk: a W'Y -_-� <br /> No. of compartments---------- ---------Siz __ _�_Liquid depth---. ----------/---------- -------Capacity-- _4;� ---- <br /> ---------Distance from foLindafion----J!P_'�-_-Distzince to nearest lotdin,5 <br /> Dispa/'Field: Distance from nearest <br /> -----------Width of trench.......—----------------- -- <br /> Number of lines----------- ...Length of each line----' g-e-2-de <br /> Type of filter material---A)"tre,_1 Depth of .filter material-------/_,�. ........Total length----- <br /> -� V -from foundation----------------------Distance to nearest lot line----------------- <br /> p <br /> ine----------------- <br /> 'Seepage-Pi+:­--DMance,to nedres ------Distance -------Size: Diameter.-. -----------_---------Depth--------------------------------- <br /> Number of pits----------------------Lining material------------- <br /> El <br /> Cesspool- Distance from nearest well---------------------Distance from foundation---------------------Lining material-------------------- ---------- <br /> El Size: Diamefe� nearest <br /> ------------Depth-,:------ ---------------- ----------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance froi­4 nearest well---_-.--- -------------------------------------Distance from nearest building-----_----_----------------------------- <br /> ------------------------ <br /> C1 Distance to nearest lot line------------------------------------------------------------------ --------------------------------------------- <br /> ---------------­-----I----------------------------- <br /> -------------------------- --- ---------------------------------- ------ <br /> Remodeling and/or repairing (describe):--------C <br /> ----------------------------------------------------------------------------------------------- <br /> - -------------------- <br /> ----------------------------------------------------------------------------- -- - - ------- - <br /> ------------------------------------------------------------------------ ----1,------------I—-------------------------------------------------------------------------------------------------------- <br /> ----------- 4 -------------- <br /> - <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will bye done in accordance with San Joaquin County <br /> d regulations of the Sah Joaquin Local'Health District. <br /> ordinances, State laws, and rules an <br /> - <br /> BY:-- <br /> Ql�and/or Contractor) <br /> (Signed)------------- ------------------ -------------------------------- --------------- ------- <br /> ------------------------------------------------- --------[Title)---------------------------_-------------- - -- ---------- - <br /> BY:-------- _0---------go, <br /> e <br /> (Plot plan, showing size of lot, location of system in reWa ion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ---------------------------- <br /> APPLICATION ACCEPTED BY---x --�_ ----------------------------------------------------- <br /> DATE- - <br /> REVIEWEDBY-------------------------------------------------- ------------------------------------ -------------------------------------- DATE----------------------------------------I-------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ ------------------------------------------------------ <br /> Alterations and/or.retommendations:------- ------------- --- ----------- -------------------------------------------------------------------------------------------------------- <br /> --------------------------- ---------------------------------------------------- <br /> ----------------------------- --------- ---------------------------------------------- -------------- ----------------------------- <br /> -----------------I---------------------------------- <br /> --------------------- ------------ ------------------ ------------------------------------------------------------------------------- <br /> --------------------------------- <br /> --------------I--------------------------------------------- ------------------------------------------------------ <br /> ------------------------------ --------------------------------- - ------- --------------------- <br /> ---------- <br /> ------------------------------------------------------- <br /> ------------- ---------------I- --------------------------------------------- ------- ----------------------------- ------------------------------------------ <br /> Date_ -------------- --------------------------------- <br /> FINAL INSPECTION ------- ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street, 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.CD. <br />