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F91Z OFFICE USE. <br /> ------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------- <br /> ---------------------- <br /> ------- -------------- --------- (Complete in Duplicate) Date Issued-_ <br /> This Permit Expires 1 Year From Date Issued <br /> ------------------- - - ------------- -------- ----------- <br /> Applica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This applica'tionjs made in compliance with County Ordinance No. S49. <br /> L <br /> ---- -------------------------- ----------------------------------------- <br /> JOB ADDRESSAND LOCATION <br /> Ve <br /> Pho eV ---------------- <br /> ------- ------J -------- <br /> ... . .. .. <br /> Owner's N�am6w: ---- - --- ---------- <br /> 7---------- <br /> ----------- <br /> Address__d.___,t4-------S:�__ Wfa <br /> --------------------------------------------------Phone-j-%. 4j<.- <br /> Contractor's Name--------------------- —- -------------- ---------- <br /> Installation will serve: Residence E'OOA'partment House E] Commercial baths <br /> rar E] tel Other ❑Number of living units: -cp2-- Number of bedrooms _s: %mber of _02- Lot size ------------------- <br /> Water Supply:' Public system El. Community system El Private Depth to Water Table-t3_0 ft. <br /> A <br /> Character of soil to a depth of 3 feet: - Sand 0 Gravel [] Sandy Loam 0 Clay L&irn El !Clay El Adobex E]Hardpan <br /> Previous Application Made: (if yes,date--------------------} No ❑ New Construction: Yes ElOX E]N FHA/VA: Yes No E] <br /> I : <br /> TYPE OF INSTALLATION AND SPECIFICATIONS; <br /> o septic'e fic�tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well-----------------'Distance from foundation__.____ ___-- Material------------------------------------------------- <br /> I PEI No. of compartments-------------------------Size--------------------------------Liquid depth----- <br /> --------------------Capacity------ <br /> -------------------Capacity------------------------ <br /> S <br /> s I Distance from nearest wel€__!�---.,JDistance from foundation____Y6_;Q- ------Distance to nearest lot line_+3_4----- <br /> Num; ber of lines__________ --Length of each line...... -------yf_­V�idth of trench' I------------------- <br /> Tptal length------- <br /> Type of filter r --------- 6 _Z 40------------------- <br /> ae,', Depth of filter material_____ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_--__.___________ <br /> ❑ Number <br /> ine----------------- <br /> Ndmber of pits-----------------------Lining material------------------------Size: Diamef&F.7--------.......Depth'""-'"'_--______________________ - <br /> Cesspool: Distance from near est well-----------------Distance from foundation------ I--------Lining material------------------------- <br /> 7-1 Size: Diameter------------- -------- ---------------Depth--------------------- ------------ ------Liquid Capacity------------------------ gals. <br /> I <br /> Privy: Distance from rearest.weli--------------------------------------------------Distance:from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line- - - --- ------------------------------------------------------------- -------------------- - ---------------------------------------------- <br /> Rem ddling and/or-repair�ng (describe)._-,_, --- ------- ------—------ --------------- <br /> ----------------- <br /> ---------------------------- <br /> ... ............Z <br /> .... ............... <br /> --- ------- - ---- --- --- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- ------------ <br /> I hereb certify that I havepreparedthis application and that the work will be done in accordance with San Joaquin County <br /> ordinance`, St fe lawWsan rules and.regulations of the San Joaquin Local Health District. <br /> -------I------- ------------------------------ wrier and/or Contractor) <br /> (Signed)-- -------- ---------- ------- <br /> By:------------ .% ---------- -------------- <br /> -_-_-------------------- - - - ---- -----W-------- <br /> - - 4. Z---------- - - -----(Title)- --------- <br /> (Plot plan, showing size of lot. location of system in relation t IIs, buildings, etc., can be placed on reverse side). <br /> ,FOR DEPARTMENT USE ONLYj <br /> APPLICATION ACCEPTED BY_-___ ------------I------ ---------------------- DATE--------- <br /> i 10-, <br /> REVIEWED BY-----------------------'.----------------------------------------------------------------------------------------------------- DATE------------------------------------- <br /> ---------------------- <br /> ---------- - ------------------ D ----------- ------- ---- --------------- <br /> BUILDING PERMIT-ISSUED------------------------------- <br /> r <br /> Alferafio�s and/o recom <br /> ------------- ------------------ --------- ------------ -------------- -- --- ----------- ---- --- ------ ------------------------------------- <br /> -- ----- ---- - ----- - <br /> ­�------------------------------ -------------- ------------- ------------------------------ <br /> FINAL INSPECTION BY:----- Date iy <br /> --- -------- ------------------------- <br /> SAN JOXQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Waxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9#h Street <br /> Stockton,Culifarn;a Lodi, Coliforn ia Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.F.00. <br />