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FOR OFtICE USE- Z- <br /> -� �--------------r9) <br /> ---------- -- ----------------------------- ----- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .�- <br /> ------------------ ------ (Complete in Duplicate) (e Z`# f <br /> ------------------------- ------_____._____"_.____"''_. Thin Permit Expires 1 Year From Date Issued <br /> 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 /> JOB ADDRESS AND LOCATIO -_--�--.I�,�,:." - - .y - --------------�---�......----------#--------•-•-----•--•-------------- •------------------•-- <br /> � <br /> Owner's Name ---- —.'. -- <br /> { <br /> Address------------ �- ----- --------- •- - --------- ------- ..........� <br /> Na le- - ----- ------ y.. _------------------ <br /> Phone- <br /> Contractor's <br /> Installation will ske: Residence Apart nt House ❑ Commercial ' Trailer ourt ❑ Motel then ❑ <br /> Number G 5�--------•--------------- <br /> Number oliving units: ___I_ Number of bedrooms .� r of baths __f__�L=bt size .,.�____�-�__...._.._ <br /> Water Supply: Public'systei Community system ❑ Private [] Depth to Water Table _7___?ft. <br /> Character of soi[ to a depth of 13 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adole�"' Hardpan ❑ , <br /> Previous A lica'tion Mader (lf es,date__________________.) Nox New Construction. YeV No ❑ I=HA/VA: Yes ❑ NO <br /> PP y / _ ` <br /> TYPE OF INSTALI-ATION AND SPECIFICATIONS: <br /> (NoePtic tankor cess <br /> e tic T 'k: Distance pool permitted if public sewer-is available within 200 feet.) <br /> f . <br /> � ( <br /> om nearest well___ _____--.Distance from fo _ <br /> undation____-__ _'_________Material------------------------------------------------- <br /> P -.YNo. of-compartments-.---- -------------Capacity--••---------------_-- <br /> Disposal Fi Distance from nearest well_ '_.------Distance from foundation____________________Distance to nearest lot line----------------- <br />� Number,;of.lines-----------------------------------Length of each line-_--:-------------------------Width of trench._...........--------------•----•-_ <br /> 1 <br /> TyApe of:filter material---------_---------------Depth of filter material------------------------ otal length_________-------------------- ��l <br /> SeepaA e �t `"'-�`Dis#once +o nearest well-,, !I __Distance from f ndation__/�__.�___.Distance to nears t loot fin <br /> (, --.Size: Diamete -- _��.--.- .De th� ? <br /> Number.of pits--...._ ;_ ____Lining materia P <br /> Cesspool: Distance frm nearest weil_________________Distance from foundation--------------------.Lining material----- .._-_____ _____..------------- <br /> ❑ 5ize:.Dameter----------------------------------------DePth--------------------._.------------- -------------Liquid Capacity---)-----------------•------gals. <br /> Privy: Distance from nearest well---------------------------------------------------Distance from nearest building--------- -____________.._-___________.._. <br /> ❑ ry <br /> Distance to.nearest lot line-- --------------------- -- ---------------------------------------------------------------------- <br /> i ' c ' <br /> 1/ j - •... <br /> Remodel` r re airin describe <br /> ... <br /> - ------------•------------------- - -------------------------------------------•-------------------------- ------------------------------------ <br /> ---------------------- -------------------------------------------------- --- -----------------•---------•-------•---•------•--------------------------•---�------------------------------- <br /> I -------------------------------------------6--------------------------------I-------------------------------------------------------- <br /> I .... <br /> -- --- ----- <br /> I hereby certify that I have prepared this applic tion and that the work will be done in accordance with San Joaquin C--------------------ounty <br /> ordinances, 'State law and r es nd regula ' ns o e:S Joaquin Local Health District. <br /> (Signed) --• --- --- --- ---------y/--- ------ ---- ----�------------------ -------(Ow ei and/or Contractor) <br /> f By:---t----------- . y = - ---- ----- -��--- c'a` ---(Title)--- �------ --------- <br /> (Plot plan, showing sl a of lot, locatio m in relation to a s, buildings, etc., can be aced on rover side). <br /> t. . .w, t <br /> FOR DEPARTMENT USE ONLY <br /># APPLIICATION PCCEPTEp BY "'" - ...� " <br /> --- ------- ------------------ ----- DATE G <br /> _ <br /> REVIEWED BY------ i ---------= DATE <br /> BUILDING PERMIT ISSUED, ----------•-L t`u zir --------- <br /> ------ DATE <br /> Alterations and/or recommendations:_____-- - _-___.___1• T,. ) <br /> I � , <br /> ---------•------------------•------------------ -------------------------------------------- --------------------------------------------------------------------------------- <br /> I -- x„-­------------- <br /> -------------------- <br /> - ------------------ <br /> .------------------------- <br /> ------------------------------ <br /> -------------- <br /> ----------------------------- <br /> - --- <br /> � t <br /> - i �71x <br /> lr <br /> FINAL INSPECTIONB 'iy----." .. Date. - �i----- 67 <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 /> i ES-9 REVIVED 0-59 F.P,00-2M 6.60 <br />