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FOR OFFICE USE: <br />--------------------------------------------------------- <br /> _----.---.-_------_--_-------------_-------- APPLICATION FOR SANITATION PERMIT Permit No. <br />--------------------------------------------------------- (Complete in Duplicate) ,�� <br /> Date issued <br />------------------------------------------------------ --- 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 thew rk herein described. <br /> This_appli.cation,is._made in compliance.with County Ordinance No. 549. <br /> JOB ADDRESS A . D OCATI N____ _ _________ __ ._ �-g`__ <br /> ..- .. <br /> G / - --- Phone................................ <br /> .... <br /> Owner's Names -- <br /> ------•---- - <br /> Address �---------- --- <br /> - - ---------------- --------------------------- <br /> Contractor's Name-------- i.... Phone--------------------- <br /> Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1----- Number of bedrooms _ Number of baths ---)-. Lot size 144-t2 o-Q----------------------_________.___.._. ?, <br /> s <br /> Water Supply: Public system'❑ Community system Private ❑ Depth r Water Table 6)--- ft, ti <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Depth <br /> Loam ❑ Clay ❑ Adobe❑ Hardpan [IPrevious Application Made: (If yes,date_-------_..__---_.-I No �]� New Construction: Yes, No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND,;SPECIFICATIONS: .- <br /> (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------.Material--------------------------.-----.- ` <br /> ❑ '---- _ _ - -•--Liuid depth-----===--- --- Capacity----------------------- <br /> No. of compartments.............. Size._.-.. ____- q <br /> Disposal Field: Distance from nearest well_________________Distance from foundation....................Distance'to nearest lot line---------------- <br /> ❑ Number of lines-----------------------------------Length of each lirf;---------------------- .---...Width of trench----------------•---.--. -._----- � b <br /> d <br /> Type of filter material-------------------------Depth of filter`rraterial----•------ ....... length--------------------------------......... <br /> Dis❑ en <br /> to res ell .-" -----------Daa from fou dation <br /> tonearest lot !� <br /> Numbeof pits - ingmateral Size: Diamer_ }�� �! Depth 19-of------------- <br /> Cesspool: <br /> ----• <br /> Cesspool: •-• Ilp�y <br /> Distance from nearest well_________________Distance from found'anon-_.��.-__-__:_____:Lining .m'ateriel__._____-__.__.__._.___________r___.: <br /> ❑ Size: Diameter--------•---•--•----------------------Depth----- Liquid Capacity gals. - <br /> Privy: Distance from nearest well-------------------------- -_-_Distance from nearest buildingi <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------- -----------• ------- <br /> Remodeling and/or repairing (describe) ----------------•-•------••----------------•--•---- ` ... <br /> I <br /> ------ <br /> ----------------------------------------------­­-----•-•-----------------•-- - --•-- _-- ----------- ----------------•-••---------------•-------------------•--••----•------------------ F t <br /> hereby certify that I have prepared this application and that the work will be done in accordance:with San Joaquin Count <br /> ordinance$, Stat laws, and rules and regulations of a San Joaquin Local Health District. <br /> s rt c. �---------------------------- ---------------------------(Owner and/or Contractor) .._ <br />­­(Signed)By ----- �. lz�.-- <br /> (Plot plan, showin 19i �"of ot�fo ration of tem r re btron tc we s, i�;fc, be placed on reveise side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE...APPLICATION ACCEPTED BY- - ---------------•-----------------•--- --------------------- <br /> REVIEWEDBY-------------------------------- ---- ---------------------------------- ----•---------------------------------------- DATE------ - --------------------------'-------------•------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------=----------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-------------------------------------- --------------------•--------------F---•- -----------.'---•-=--:_:::: - <br /> ----------------------=---------- ------..-----•--------- ------•---------------------------------------------------- -••----------------••------•-••--------------------•-----------•---•--------------------._-......- a <br /> --------------------------------------------_---_----------------h_--..........---.---------------------------------------------------------- ------------- <br /> -------------------.--------------.--------------------......... <br /> FINAL INSPECTION BY: ' -. _._. r : 3 <br /> ------------------- Date w <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street :.i 300 wast Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California ..t. Manteca,Callfoinia Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br /> J <br />