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` ? _ FOR OFFICE USE: <br />.__________ __________ APPLICATION FOR SANITATION PERMIT Permit No. _�'._?._:��..�' <br />------------------------ -- ---------------------------- (Complete in Duplicate) <br /> --W -_--_________..__ This Permit Expires i Year From Date Issued Date Issued ....._ ..._. 11 <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 /> JOB ADDRESS AND CATIONS h``�' <br /> Owner's Name.......... ... ---I- . -------•-------••---• <br /> ---------------------- <br /> Address -- ••••-- ---------------•-•"•-......-•---"•-- •---- <br /> / �^ Dom/ <br /> Confiractor's Name �, 1t _ __�!.-c_...----•----•--•. "-"-___-_""-•......-••---•-• Phone......: lG'.. <br /> Installation will serve: Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> r <br /> Number of living units-_-/--- Number of bedrooms `g!!77 ^Number of baths I--- Lot size --------'..e....x..f <br /> Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table ft. C, <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date------_-------------I No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> tic Te : Distance from nearest well------------------Distance from foundation--------------------Material................................................. <br /> No. of compar.�its" ----------- -=------Size--------------= ...........Liquid depth--------------------------Capacity-----•--•---........•. <br /> S F' Id. _Distance from,ntsarest well.....�?>'�----Distance from foundation__------------------Distance to nearest lot line............... <br /> Number of line-s=------------------------7J-----Length,of each line---------------------.----.Width of trench....................____.,:,;.......... <br /> Type of filter,'material_____________ _____ g Depth of filter material__----------------------Total length------------------------.__ . <br /> See a a Pit: Distance to nearest well___HI .._.pistanc om oundatlon__ _______________.Distance to nearest lot line____.___.._..._.. <br /> Number of pits- i -._,-_,Lining material_ 4. _ . ------Size. Diameter.—3.3 . ,De th.Z.,-r'.._ <br /> � p <br /> Cesspool: Distance from nearest well_________________Distance from oundation___-______-________.Lining material..................... � <br /> ❑ Size: Diameter-- ----------------------------------Depth----------••--- ------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----------------------_________________________Distance from nearest building------------------------------------------ <br /> Cl Distance to nearest lot line------------------ ------------------------------------------------------------- "-----------------------------"--"------------------- <br /> Remodeling and/or repairing (describe):----------------- ---------------------------••-------- ------------------------- • -------------------------•---------•---------•--------•------• :. <br /> ---------------------•--••--"•-----•-•--•-----••-•• ----------•--- -- --------------- ---- -•---------------•----- - - -"-----------------"------- <br /> ----------------------""-•-"-••-•-• •--•-•---"--- ----------------- - - T ._............ -- ---- """--- ------------------------- <br /> -------••---------------•--•-----•------•--•--•------.--, -------------...._.................................-----------------•-------------•-•---•--------•---------- •-•---"-------------------- ----- <br /> I hereby certify that] have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed]/� ----"".a_..47 ...._.. yv�f----- 1__/f------------- .( ontrector] <br /> By:.................................... ------------------------------------- `.`•. --•--- ----------(Title).-.----------------------------------.-------------------------- <br /> (Plot plan, showing size of lot, location of system in relay to well; building tc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- '"7-'�J----- DATE - ....- <br /> REVIEWED BY--- -----_-------•...... ......... ----- -------y-I-'--•--......---- DATE------------_------------- <br /> BUILDINGPERMIT ISSUED --------------------- ----------- `---•----------------------------- DATE--------------------------------------------.........-....... <br /> Alter io /or recommendations:---'' -----'10-- �---�-----��-----33_" ��5.� 7..._�'_� �� <br /> --- ----•------•---------- ---- �' -._... <br /> ..........--.:---------------------------------------------------------------------------------------------------------------------------------------------------- •----•----•-- ---•---•---------------•--------------- <br /> ....--•-•-•--.._.."---"•-- ---------I.,.......... ...•--•-•----------•-••------------••------------------------------------------------------------------------------------•........................................ <br /> --------------"---"+--------- ------------------------------.--•--- --•- --------••-------- ----••----------•------------•-------•--•---- •------- ------------------------------------------ _...------ <br /> s : . <br /> FiNAL'.INSPI=CTION BY:. - - """ --- -- Date -�' �_/&------­------------------- -�---••--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <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 <br /> ES'4 REVISED 6-$9 2M 9-61 ATLAS - <br />