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FOR OFFLCE USE: _ <br /> ------- - r <br /> APPLICATION FOR SANITATION PERMIT Permit No. .- -6...� ._- <br /> --- ------------------- ------- ---------= a <br /> -- ------------------------- <br /> (Complete in Duplicate) <br /> This Permit Ex fres 1 Year From Date Issued Date Issued 1,2�71�� <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 /> . f. <br /> I JOB ADDRESS L I I , <br /> s-- ---- <br /> ---- <br /> ---- <br /> Owner's Name„ ---"- <br /> 0 0 <br /> � , <br /> to --- - Phone- -_ <br /> Address-. / <br /> w? ' <br /> Contractor's Name--- � '" - - <br /> --•---- ----- ------ + Phone,.-'"�' - <br /> ¢ ir <br /> Installation will serve: Residence Apartment House ❑ Commercial <br /> ❑ Trailer Court ❑ Motel ❑ Other ❑ \ ,. <br /> Number of living units: --__ --- Number of bedrooms Z5 Number of baths --- Lot size ------------ <br /> -_ <br /> Water Supply: Publics stem <br /> y ❑ Community system EP- rivate ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loamlay Loam I] Clay ❑ Adobe[I Hardpan ❑ <br /> Previous Application Made: (If yes,date------------- <br /> -------) No ❑ New Construction: Yes � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - '-' o ❑ FHA/VA: Yes El No E] <br /> No se0ic tank or Cesspool permitftd if'ubiic sewer is available witliiii 200 fee <br /> Septic.Ta Distance from nearest well--- ___pistanc� fro fou a _� —., <br /> F ----.Material. `. <br /> ,.. <br /> No. of compartments.-� ,_ + 7Ln--_-- <br /> - ---- ,-----...$ize-�----•�-------� �"_Liquid depth- ---- -- <br /> t � ---Capacity--•CCS ` <br /> Disposal Fie Distance from nears . welL_ #G Distance from foundat' n�-.__c-_. <br /> --.Distance to nearest lot line--tl­Number of lines_F___- <br /> - <br /> - -- Leng}h of each line_ _Q_:�,�f�_'SNidth of trench_-.._ <br /> ..�- <br /> Type of filter materia,-.- De fih of flier material__-._ _. /.f' f <br />` p <br /> ------ Total length-------------� t�_ <br /> ------------------ <br /> 9 ----------------------Pit: Distance to nearest well'-`--_--___--__-----Distance from foundation--------------------Distance to nearest lot line-_-_____________ <br /> F � , <br /> ❑n Number of pits--- ----------- ----Lining material------.--- ----------- Size:`Diameter <br /> Depth-- --------------------------- <br /> Cesspool: Distance from nearest Well-----------_-----Distance from foundation_____________ V <br /> t " <br /> ------Lining material--------- ------- <br /> Size: Diameter = I--------------------.De th---------------------�--- <br /> Priv I! i p + ---r--.Liquid Capacity--- ----------------- gals. <br /> y Distance from nearest well-----_________'_------------------ --- -_Distance from nearest buildin <br /> g- <br />�' ❑ Distance to nearest lot <br /> �" __-___ <br /> ------- <br /> Remodeling and/,or repairing (describeJct_--- <br /> 1,. p . 4 <br /> - - ------=----- <br /> t <br /> I <br /> _. --------------------------------------------------- <br /> _-----r--- --------------""----- -- --.i <br /> I hereby c tify hat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S � <br /> �` a .eules 'regulation of the San Joaquin Local Health District. <br /> (Signed ' <br /> +�� ----- <br />..;c �...------ oar Contractor) <br /> = -- <br /> � • -----C, <br /> - - 4,�. _----- "-�`- _[Title)-- -=-­---- <br /> ------------------- - _ ....�. <br /> (Plot plan, showing size of lot, location of system in rely ' n to wells, buildings, tc., can be placed on reverse side). ` <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ _ DATE ,1-Lsr�.-=�-5--~ <br /> ------------ <br /> REVIBUEWED BY ------- ------ ► <br /> -------- ----- --- --------- �--_-..-- ----- - -- - ---- DATE----------------'"-�--- - - ' <br /> -- - -------------------------------=- <br /> ILDING PERMIT ISSUED - - ------------------------------ <br /> ---------------- DATE--------------�-- <br /> Alterations and/or recommendations:._�_..__-.__.___-__--_- "-- --- ""-"- ------I- •-----`- -- <br /> ---------- - ----------------------------- <br /> -- ------------- <br /> -------------------------------- ----------------- <br /> -------------------------------------- <br /> - ------------ --------------------- x <br /> ---------- --- <br /> ------- ------ - <br /> FINAL INSPEC BY - Date---------1-.�_,3_"`�j <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT { <br /> 1601 E.Haxelton Ave. 300 West Oak Street 114 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> n <br />