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FOR OFFICE USI=.. 3 Ifl <br /> 'I" I Permit No. <br />------------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT <br />----------- - <br /> -------------------------------------------- (Complete in Duplicate) Date Issued ...... <br />---------------- --------------------------------------- This Permit Expires I Year From Date Issued <br /> ---------- ----------- t for a permit to construct and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health District <br /> This application is made in compliance with County Ordinance No, ,549. <br /> ----- ----------------- <br /> TION 3­ <br /> JOB ADDRESS AN_D�CA ------�J. ------- -- ------ I ... <br /> P..-Ine...... <br /> Owner's Name_______________________ <br /> _......E_,---------- <br /> Address-------------------- -_-------- ---- ----- <br /> -----­----------- ---------- <br /> Contractor's Name— <br /> I--.— Commercial Trailer Court Motel Other 0 <br /> Installation will serve: Residence ff Apartment House 0 .4 .1 <br /> Number of living units: Z_ Number of bedrooms Number of baths Lot size --- ........................ <br /> Water Supply; Public system Community system [] Private J—] Depth to Water TableGravel 0 Sandy Loam Ej Clay Loam ❑0 Clay ❑ <br /> 0 Adobe Er-"Hardpan C] <br /> Character of *oil to a depth of 3 feet: Sand [I Gravel <br /> ) No E11- New Construction: Yes [ No C] FHA/VA. Yes [3 No P�r <br /> Previous Application Made: (if yes,date---------------- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: s available'within 200 feet.) <br /> {No septic tank or cesspool permitted if public sewer i <br /> ep T k Distance from nearest well-----------------Distance from foundation---------_--------Material------------------ <br /> ic a - .. ....Liquid depth------- ------------------Capacity------................ <br /> No. of compartments---------_--------------Size------_--------------- --- f <br /> tic ,"f� _---Distance to nearest lot line................ <br /> I F* Id Distance from nearest well _-- _.-Distance from founclation-,�/O_%--- <br /> sa 1 .1 ----2r- �O� of trench_ -------------0--------- <br /> --------------- --- <br /> Number of lines------- of each line-- U; <br /> Type of filter material -- - ------Depth of filter materia - ---- ---Total length..._...Al —P.4-------- <br /> 1 15-1 <br /> Distance to nearest well-.-_! -----Distance fr m foundation----j. ..........Distance to nearest lot !ir-e------------- <br /> Seepacle Pit: Number of pits......I--------------Lining material--- .-Size: Diameter__:_.-- Depth---��A <br /> V Lining material---------_---_--------­---...... <br /> Cesspool: Distance from nearest well_---------------Distance from foundation-------------------- - ----------------------------gals. <br /> 0 Size: Diameter--------•------------- ---------Depth---------------------------------------------------Xquid Capacity <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building--___.-___-_.___.___._..._.__.___.._...__. <br /> Distance <br /> uilding------------ <br /> Distance to nearest lotline------------------1_________________ - <br /> Ab-------- <br /> escribe - ------- - -- --- ------- - ------ ..... <br /> Rem ling and/or repairing ---- ------- <br /> --- - ---- --- ----- ------- <br /> ----------- ------------------------ <br /> -------------------------------------I--------­--------------------------------------------------------_­ <br /> . .. ... . ...... ... ---- ------------ 4� ----- ------------------ <br /> ------------------------------------------_----- <br /> ------ - ------- -- --- - -------- ---------- - --I------- -- ------- ----- ----- ---- ---- -- ----- <br /> --I--hereby-certify- __that-- .I__have.-prepared- --­this-application- .-- .-and__that__the..work­will­ -be done in accordance with'San Joaquin County <br /> ordinances State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Owner and/or Contractor) <br /> ........ ----- <br /> ------------ <br /> �qL'Axel <br /> (Signed <br /> ---- -------- <br /> --------- ------ <br /> 41 -------------------------------- ...... <br /> ---- ----------------------- -------- <br /> By:-------- ..... ....... in relation to wells, buildings, etc., can be placed an reverse sid;V Sjo <br /> (Plot plan. sh rwsize f lot. location of system <br /> FOR DEPARTMENT USE ONLY <br /> ------------------- DATE_......... .......2�------------- <br /> ----- ----------------------------- <br /> APPLICATION ACCEPTED BY____________ <br /> ` ---­-------------- DATE-----------_-<17-----_--------_----------------------- <br /> REVIEWED BY. .... ---- <br /> BUILDING PERMIT ISSUED-_----------------- -------------------------_---------------------------- DXTE--------- -----------_----------------_--------- <br /> --------------- _ - 4- 1------------­-------------_------------- <br /> li <br /> ------- 1 <br /> I--- ----- ........Alterations and/or recommendations:-----_.-----.__-------------- --------- --- ---------- G- ------- ... <br /> -------.------------------------------------------ <br /> .-.-.-.-.-.-.-.-.-.-.-.---.--.--.--.--.--.--.--.--.--.I-.--.--­------.--.--.--.--.--.--.--I-----------------------------I------------------------------------------------------------------------------------------------------------------------- i--- <br /> -----------_-- <br /> -----.-.-.-.-.-.---.---------.-.--.--.--. <br /> ....................................................... <br /> ------------------------------------------------------------------------------- --.--.-- <br /> .-...... ------------H----- <br /> ----­--1----------------------- <br /> - <br /> --- ---- •-_--• ---._ <br /> ----------- <br /> - <br /> --- <br /> FINAL INSPECTION BY------ ---------- ---------•------------------------------------ <br /> Date-------- ----- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 sycamore Stree 205 es 91h Str <br /> Stockton,California Lodi,California Manteca,Callforni c/,California <br /> ES 9 REVISED 5-59 2M 5-61 ATLAS • <br />