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APPLICATION FOR SANITATION PER.MIT�� Permit No. <br /> (Complete in Duplicate) 3�/�/S <br /> gate --- --- ----- <br /> Issued ; _ _ _ <br /> lication is hereby made to the San Joaquin Local Health District for permit to construct and"install the work herein described. <br /> _iThis PAppapplication is made in compliance with County Ordinance No. 549. ", ,.. <br /> O ADDRESS AND LO ATION _. [7 _ _ <br /> . `1` <br /> FOwner's Name------ ��,. . <br /> = -- ------------------------, ._ _. . f _ . -- -Phone------------ - <br /> Address------------------------ <br /> - ---------------- -----------------•--------------------------------------------------- <br /> Contractor's Name---- =-- - /i--' = - --- -•--- - - ------ ---.Phone <br /> I fallation will serve: ° Residence lApartrrfent House [] -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑. <br /> Number of living units Number of b,�edrooms ' cr_ umber of baths __ _ Lot size .,_ys/j _ ______.____ <br /> I Water Supply Public system, ❑ Co munity-systeem`❑ Pi jvate' epth.to Water fbl6,1q <br /> Character of soil J-3 a;de +h"of 3 feet: Sand r i Gral <br /> P•� io A E �€ - 0 Sandy Lam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> ,rev us Application Made: Yes ❑ i`lo [ j'�New Construction: Yes ® No FHA/VA: Yes ❑ No ❑ <br /> PE-OF INSTALL'ATION-AND SPECIFICATIONS: t <br /> {No sep+ic.tank`or cesspool permitted if public sewer is available Ain 200 eet.) A <br /> ti, k: o Distance from nearest well 'Distance from foundation___ Material <br /> // <br /> No.�of compartments_ �'Size :---------------------Liquid depth _. - � _�Capacify-------- ----------- <br /> 4 ' Y ► � `� I <br /> Disposal Id: Distance from nearest well_ O. _©,stance from foundation_, !� Distance to nearest.lot line___...__._ <br /> { <br /> FT ' e of'.filter material_ th of each line________ ���. _-_.Width of tren h.__. -�� ______ <br /> I yp De # <br /> t t ___ r Deng <br /> _ p.h of filter material__:.:�� --.___ _____.- <br /> See a e Pit: Distance to nearest well__________________ Distance from foundation-_________--_°..___.Distance o nearest lot lisie___=M_=.-..------ <br /> ❑ Number of pits i_______________Lining material '_'.'_.:_ ' :__.Size.' iameter_ :. ___-.De th_:___..___:... <br /> P --- <br /> Cesspool: Distance from near`est`well___= :___€_D`i§tante from foundation""' Lining material--------------• __________..__--____._ <br /> ❑ Size: Diameter -- --- 1 Depth----------------------------------------------- -----Liquid Capacity ---------- ---------ga <br /> .t - <br /> ---_-______Distancfram7mearest building.;. ______________ <br /> Privy: .�Distarice from nearest well___ �" " ` <br /> ❑ Distance to nearest'l'ot`�I ne"�'"'""'v -- - ----------------- <br /> ' ' - t _._ _ .__ <br /> Remodeling and/or repairing (describe)- -------------------------- ------ - --------------------------------------I-----------------------­ ---------- - <br /> f. i <br /> 1 here rtify that l have pry orad this apphca+j_r _'k d +h the work will be done,in,accordance-with San Joaquin-County <br /> ordinances 5 t law nd r l an regulations af'the`San+J aq in Local Health District. , <br /> Si ned - ------ - - --- --- -- -- - n o iConfracfor <br /> g )----- ,owner a d/ r,t <br /> ---- Title---:-- -- <br /> (Plot plan, showing size of lot, location of system in.rel ion to wells, buildings, etc., can be placed on reverse side). <br /> ' ' R'F DEPARTMENT USE ONLY <br /> • <br /> APPLICATION ACCEPTED - ----- <br /> 'BY - ------------- ----- DATE_---------------� = <br /> REVIEWED5Y ----------' _ -------------- ---------- ---- DATE_. 3--------------------------------------------------------- <br /> BUILDING PERMIT 15SUED ---- <br /> = DATE -----•- <br /> - <br /> Alterations and/or recommendations:--------- ------------•------•-------------------------------------------•-----•---• -------------------------------------- <br /> - <br /> ) <br /> -------•------ ------------------------------------------ -------------------------------------------- --------------------------------- --------•---------------------- ------------------ --- ----- <br /> ___________________________________________________________ <br /> -------------------------------------..____.----------_----------------------------------------------.___.--------------------------------i Ic-, <br /> -------- _ <br /> J B <br /> -------- <br /> FINAL—WSPECTION'$Y -,2�11 - - • - - ��=`-- --------------- Date-'-- - =-----------9 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West.Oak Street 132 Sycamore'Street 814 North "C" Sheet <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revises 1.57 FY.CO. j, <br />