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FOR OFFICE USE: it <br /> ------------------- ----------------- ---------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complefb-in Duplicate) <br /> -------- ---- --- --------------- --------- Date Issued <br /> ----------------------------- This Permit Expires 1 Year From Date Issued P,57-110 --D& <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, <br /> th County Ordinance No. 549. <br /> This application is made Bance-with <br /> --------------------- <br /> J6 ------ ov-)0,0 ---- - ---- <br /> B ADDRESS AND LOCATION ne---ro <br /> Owner's ------i------ -------•-------------------------- --------------------- ----- ---------- Phone. . <br /> ------ -------------------------- <br /> Address---- ---------- <br /> ---------------------------------------------------------------------------------------- <br /> Contractor's Name------ ---------- ------- -------­-------------------------------------- Phon <br /> Installation will serve: Residence Apartment House E] Commercial [] Trailer Court [I Motel Ej Other. E] <br /> XAP,�F- �---------- -------------- <br /> Number of living units: I---- Number of bedrooms --,Y Number of baths Lot size _--_. .._C -- - <br /> q ei <br /> Water Supply: Public system El Community system El Private-g Depth to Water Table 4"`ft <br /> Character of soil to a depth of 3 feet- Sand []--'Gravel E] �S`andyll­oarn ❑ Clay Loam F1 Cay [] Adobe C1 Hardpan E] <br /> Previous Application Made: (If yes,date.--------- No fD' New Construction: Yes 0 No P,-rHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND SP—ECI`Flc)(TrONSf -'----- <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-..-------------- - ------------------- -------------------------- <br /> ❑ No. of compartments------------------- -----Size--- -. Maferia <br /> -- <br /> ----z- ----- ----- -----------Liquid depth- ------- ------- ------. Capacity-------- -------------- <br /> Disposal Field: Distance from nearest well--L5..0 Distance from founclafion­/1P---------Distance to nearest lot line_+t_;__..__._____ <br /> Number <br /> :;----------- <br /> Number of line,------------/-------- ..-Length of each line__._.___- -_-----..Width of trench.--,;_;,---------------------------- <br /> Type of filter material---- Depth cTf,filfer material <br /> --------..Total length-------7 ------------------ <br /> Seepage Pit: Distance to nearest well--------------- ------Disfancefrom foundation___________________ Distance to nearest lot line___...______._. <br /> Number of pits--------------------Lining material--------------------- Size: Diameter--_---------------.----Depth---------._--_---------------- <br /> iCesspool: Distance from nearest well ----------------Distance from foundation--..-.---- ------ --Lining material____......_.___.____.___-------_____. <br /> ❑ <br /> aterial--------------------- --------------- <br /> n Size: Diameter. .. .------- ----- -------- - - ---Depth--------------------------- --- ------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well...............___..-.--.--._._---.---------.--Distance from nearest building...___--_-------------------------------- <br /> ❑ Distance to nearest lot line------- -I------------------------------------------------------------------------------------------------------------------------------------ <br /> Remodelingand/or repairing (describe):------ ------------------ ----------------------------------------------------------------------------------------------------------------------------- <br /> --- --------- ------- -----------------------I------------------------------ <br /> --------------------------------------------- - <br /> ----- - <br /> r <br /> r--------------- --------------------------------- -------------------------- <br /> ----------------- ---------------------------------------- --------------------------------- ----------I——-------------------------------------------------------------------------------------------------------- <br /> --­----------------- ----------- <br /> -----------------------------------•--------------------------------- --------- ----------- --------------------------------------------------- <br /> I <br /> -------------------------------------------------w-I hereby certify that I have prepa(ed this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and`regulations of the San Joaquin Local Health District. <br /> ..... .........4---------------- ------­-------------- ----------------(Owner and/or Contractor) <br /> --(Sig ned)--4Dvi--z-, —�- --------- <br /> By:------------------------------- ----------------------------------------------------- --------------------------------------------1 i ----------------- -------- ------------- ....------...._..--- <br /> (Plot <br /> ------ --------- <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildingl, etc., can be placed on reverse side). <br /> A <br /> FOR D ARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------- = -------------------- ------I--------------------------------------- DATE--------- -7---7 67------------------ <br /> REVIEWEDBY----------------------------------- --------- ------------------------- ------------------------------ --------- ------ DATE-----r-------------------------------------------------- <br /> BUILDING PERMIT ISSUED <br /> DATE--------- -------------------------- --------------------- <br /> ­------ DA <br /> Alterations and/or recommendations:.... -----------------r- ------ ------ -------------------­---------­­-------------------- ---•--•------------------------------------------- <br /> ­----------- ---------- ------------------- ----------------- ------ - .. .... ............. ------- ------------------------- --------­-­------------------------------------------------­­---------- <br /> ---------- -----------------­­----------------­---------------- -- ------------ ----- ----------------------------------------- ----------- ------------­­------I------------------------------------------ - --------- ----- - --- ----------- ------ -- - - --- ------------------------------- ---------- -------------------------- --------- ---- ------ --------------------- <br /> - ----- ----------------- --------- ---------- ---- - -------- -- - ----------- ----. . . .......... ---------------- ---------- ---------------- ------ -------------------------------- ------------- <br /> - --------- <br /> FINAL INSPEC Date.---------- ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />