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FOR OFFICE USE: <br /> ----------------------- -- ----- ----- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------- - --- -- i <br /> ------------ -- ---- ------------------------------------ (Complete in Duplicate) <br /> Date Issued <br /> 20!� -------------- This Permit Expires 1 Year From 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 Ordinan e NO 549. <br /> .10�1 . — <br /> JOB --- -------- <br /> Owner's <br /> JOB ADDRESS APO-i K;", - I <br /> _�OCATI <br /> Owner.s Name_'._AA_ ------- ---- --------- ---- ---------- -- ---------- ----- -------- Phor --------------- --------- <br /> \j_ % 0 <br /> Address---- ------------------­ ------------ ------ ------!,---------------------------------------- <br /> -------------------- ----------------­- <br /> Cc�nfractor's Name- -- -- -- -- -- -- ----------------------------------------------- Phone---------------------------- <br /> lns;allafion will serve: Residence E] Apartment House El Commercial E] Trailer Court E] Motel E] Other E] <br /> Number of living units: ----V _:__Number of bedrooms _'_ umb;r baths -:-/--- Lot size ------ -------------------- <br /> Water <br /> D :a�'j <br /> r Supply: Public:system -E]....Comm unity system El Private I Depth to Water Table ---- ft <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy L6am ❑ Clay Loam ❑ Clay �/Aclobe❑ Hardpan 0 <br /> Pre"Vious Application Made: (If-yes date--------------------- No ❑ New Construction: Yes E] No FHA/VA. Yes [:1 No F1 <br /> 4, <br /> TYOF INSTALLATION-AND SPECIFICATIONS: <br /> (No septic tank or cesspool pertniffied'ifpublic-sewer ii­aviiila-61ii within 200 feet.) <br /> Septic Tank: Distance from nearest well------------------Distance-from foundation__-L-----------"-.Material------------------------------------------------- <br /> 1\ <br /> El No.;of compartments--------------------------Size---------------------:------ Liquid dep-fl­ q- ------------- --------Capacity_-------------- <br /> foundation--- --------- <br /> Dispos Field: Diifance from.nearest well......la!Distance from -1! Distance to nearest lot line-----5 <br /> ....Width of trenc -------------- <br /> Number of-line"s--------------J-------------------Length of each line--------/__6 h 1x_I------- - <br /> Type of filler.m terial--------5R---------Depth ofijiTte'r material____�ef_ __Jotal length--------/_0V------------------------- <br /> . 1 -4& . #', "it <br /> ,See/paPif: Distance to ne'a' rest well-----I-00--------Distance -;Ois'tance to nearest lot <br /> Numbe.r'of pits -- <br /> -----------Lining mat Size: Diamete'r------- ----Depth---z2 ............... <br /> C:N- -% I <br /> Cess pool: Distance from nearest well------------------Distance' from foundation..... ......... material__.___________---------------- <br /> El Size: Diameter------- ---------- -------- ---- ----Depth-----------------------------------------------------Liqui& Capacity----------------------------gals. <br /> Privy: <br /> Distance from nearest well--------------------------------------------------Distance from,nearesf building________________.______________________._. <br /> Distanceto nearest lot line----------------------------------------------------------------------- --------------------------- ------------------------------------ <br /> - -- ------- bv ------ --- -------- <br /> - ------ ------ --- ------------- <br /> Remodeling a r' air'%cd/or p i r 9 (de!.� ------ <br /> ------ ------- --- -- - ----- -�-i�------- --- -------------------------------------------------------------------------------------- ___________-- <br /> I ------ ------ <br /> ------------ -------------------------- ------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------- -------- � - --- - I <br /> ------------------------- . ­------ - ------- ----------- ------------------------------ -------------------- --- <br /> ---7-------------------------------------------------------------------- <br /> I hereby cepif -0 � that`f- �'� wtil be done in accordance with San Joaquin County <br /> . jthat I have p4pared this applicati'n and.th'atf- e work � I <br /> r I s of the San J6aquin Local Health District. <br /> ,es S, la <br /> ordinances, and rules u ation <br /> n <br /> S 9ned)____' ----- ----- - - -------- ------------------------------- ------ nd/or Contractor) <br /> i --------- - - ----- -------------- ---------- <br /> 4i. <br /> (Title}- <br /> --------------------------------------------------------------- <br /> ---- ------------------------ ------------------------- <br /> ­ -- ------ -- V_- <br /> (Plot plan, s owing size of lotJocation o system in rV ation to wells, buildings, etc., can be placed on reverse side). <br /> FOR-DEPARTMENT..USE ONLY <br /> APPLICATION ACCEPTED BY-------- - ------- -------------------------------------- DATE-----/! ------- ------------ <br /> REVIEWED BY------------------------------------f <br /> -------------- ------- ----------------------------------------------------------------- DATE----------------------------------------------------------- <br /> BUIL5ING PERMIT ISSUED---------- I-- -- - - —------------------------------------- DATE.---------------------------------------- - <br /> -I --------- <br /> L,�,,_�,Alfe'ra+ions and/or recommendaf ions:--------------------- ------------------ ------------------------------------------------------------- ------------------------------------------------•.----- <br /> I ---------------------------------- ---------------------- ---------------------------------------------------------------------------------------------------------------------------- <br /> L <br /> ------------------------------i---------------------I------------------------------------------------------------------------:-r------------------------------------------------------------------------------------------- <br /> ---------------- ----- ------- -- ----------- --- ---•---------------------------------------- , ------- ---------------------------------- ----------------------------•-------- -------- <br /> -----------r............•--------- ----------------- ----------- - --- ------------------------------------------------------------ ------'-------------------•---------------------- - --------- ---------- <br /> FINAL INSPECTION BY..---.. -------------­--- Date....11-1-f .........._-_-.- <br /> SAN <br /> .......SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Mo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stack%n,California Lodi,California Manteca,California Tracy,California <br /> E5{ <br /> 9 RrvisEo 9-59 3m 3-63 F.F.013. <br />