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'y APPLICATION FOR SANITATION-PERMIT Permit No. ____. <br /> (Complete in Duplicate) <br /> ` J J T _Date issue / -5 <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. -y <br /> _1-1J o <br /> JOB ADDRESS AND LOCATION-•--- '`r �j ------------- <br /> Owner's Name-- ------- c '`�°c'r� 4 o ----"---------------------------------- ------------_---- ---------------------- Phon �?"" 7/T- <br /> Address.----2-rf- A--- - ----•------ ----------------------------------------------------------------------- -------------------T <br /> Contractor's Name__C __ ------ ------------------- -- -----•-------------•------------------ Phonel7-4 <br /> Installation will serve: Residence qj-Apartment"House'❑ Commercial ❑ Tra`ler Court ❑ Motel ❑ Other ❑ <br /> t <br /> Number of living units: /---- Number of b1I6edrooms _j;7-__ Number of baths __X_ Lot size ___� _________________________ <br /> Water Supply: Public system [Community system ,❑ ,Private.❑ Depth to Water Table YA ft. ' <br /> Character of soil to a depth of 3 feet: �nd ❑. Gravel E] Sandy ami❑ CI ay L am ❑ Clay El Adobe [Hardpan E] <br /> Application Made: Yes ❑ No 2! New Construction. Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if }public sewer is available within260feet:). s <br /> Sep ic,Tank: Distance from nearest well____"______-__Distance from foundation_�___I_--______-Material______________ ____"_-___________.________-_. <br /> partments - Size--------------------- ------Liquid depth.-------------------------Capacity----------------------- <br /> p No. of comm nearest well____"__..____Distance from foundation_" .__------------Distance to nearest lot line_________________ <br /> --- <br /> is sa. Field: Dumber of lines------ -----------------Length of each line--------------------�-,_r --..Width of french----------------------------------- <br /> Type <br /> ----------------------------_"""--T e or filter material:__-__"_ __ ______-_-De th of filter material------------ ____Total length__________________________________________ <br /> 1 ___".�_y_,__Linint material_�t _S-ize: j D1stance to nearest lot line__S____.--__ <br /> Seepage t: piUabnee of pn+crest II / �- """Distancerbr'i foundationiameter___ ��___._____.Depfin______ .5+-�________________ <br /> Cesspool: Distance from om nearest well-------------_____Distance from foundati n __-_ _ ._.___.Lining material__"_".___________________________.- <br /> ❑ Size: Diameter----------- ---- °----=k-----Depth----- ------ --------------- <br /> Privy: <br /> ---- ----- R Liquid Capacity gals. <br /> y ' <br /> ❑ Distance'to nearest°lot line_'"�___ Distance from nearest building_^__________.___________________-_"____. <br /> Priv Distance ,rom nearest yell__.-_-_." <br /> Remodeling and/or repairing (describe):-{ - -- ---- -- _ _ •� °_ ----------------- -----------------•--•---------------•- <br /> ----------------------------------- <br /> .r <br /> -------•--------------------- ----------- ---;----------------------------------------------------------------------I-----I-------L-----------------------------------___--------------------- <br /> 3 .. <br /> --------! hereby certify,that I have prepar---------------------------------------------------------------------------------------�•-----------------------------------------------•- ----------- <br /> ed ibis application and that the work will be doke in accordance with San Joaquin County <br /> ordinances, State laws, and rules andpiegula#ion's of"the San JoaquinyL'iical"Health�`Dis#tic#. <br /> (Signed) / ... --------------------- ------ - ------( caner and/or Contractor) <br /> By:--------------------------------------------.1 --------------------------'_(Title)- <br /> (Plot plan, showing size of lot;location cFsystem in relation to wells, buildings, etc., can be placed on reverse side). <br /> y ' <br /> FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY------------------------------------------------------- ----- DATE--=--------•-- -�U--JSP--'- <br /> REVIEWED BY---. ----------------------------------------------------- <br /> -----� -8---------------------- <br /> °--------- -------�-- --------------------- --------------------- -- ----------------- DATE--------------"----••--••-----------.....--------'---------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------- -- ---------------------------------------- <br /> Alterationsand/or recommendations:-- ---------- ---------------------------------- ------------------- ----------------"-•---------•------------------- ------------­- <br /> --------------------------- <br /> z ; <br /> ------------------------------------ ------ ----- <br /> � �� _5 <br /> s ------- Date-----------------�------- - --------•-------G/-------- <br /> ---•- <br /> FINAL INSPECTION BY:----- ------ - •-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />