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FOR OFFICE USE: <br /> .- APPLICATION FOR SANITATION PERMIT Permit No. _ __ :..'`5 <br /> ------------------------------------------- --------- (Complete-in Duplicate) <br /> This Permit Exl2ires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in.c!?Mp1!iarjce with County Ordinance No. 549. <br /> JOB ADDRESS AN LM�TIO _v(1949 .L_ --------------------------------- ----____s<1� . .. <br /> Owner's Name Q Phone------------------------------------ <br /> Address-------- --------- I <br /> Contractor's Name__. -- - ------------- Phone------------------------------------ ion <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer ourt ❑ Motel ❑ Other ❑ "� <br /> Number of living units: _ ___ Number of bedrooms ,. _._ Number o aths ________ Lot size ___f- � _ ______..___________________ <br /> Water Supply: Public system ❑ Community system [) Private Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand [] Gravel E] Sandy Loam E] Clay Loam E] Clay Adobe❑ Hardpan ❑ ' <br /> Previous Application Made: (If yes,date_....__.._....__--. ) 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 /> ❑ No. of compartments------- ---- -------- ----Size-------------------- -----------Liquid depth-------- ....... -- --- Capacity----------------------- <br /> Dispos Field: Distance from nearest well..40--/__Distance from foundat'son___/�_.........Distance to nearest lot line_-S__`------ <br /> Number of iines----- <br /> /------------------------Length of each line-- ----- .........Width of trench.-._-4�-.'--.-------- ------ <br /> Type of filter material---c,5.!L............Depth of filter material-------15�.".__._Total length----------5;2_l-----------___ <br /> See pa Pit: Distance fo nearest_..._.f_PAV-.",_Distance from foundation_-__ /------ Distance to nearest lot <br /> p --------Lining material......�'�____ Size: Diameter------------- _�--- Depth__-•Z- --'______________ <br /> Number of its___ ___________ <br /> Cesspool: Distance from nearest well -------------___Distance from foundation_----------..... ..Lining material-..-__-_--__-- ----..__._____________ <br /> ❑ Size: Diameter- -- --------- ----- ----------------Depth.------ --------------------------------------------Liquid Capacity- - ---------------- -------gals. <br /> Privy: Distance from nearest wel{-----,;.___v------__________-------_---------_Distance from nearest building----------------------________.._____--_. <br /> ❑ Distance to nearest lot line <br /> F kX, <br /> ,�----------------- --- <br /> Remodeling and/or repairing (descri .)� •• ---.. <br /> ------------•----••------•-•-•--------------------------- --- <br /> -------•-------•----------------------------------------------------------------------- ------------------------------------------ ----------------- . - ----------------------------------------------------- - <br /> ---------- -------------------------f----------------------------- ----------------------------------------------------------------------------------------------------------------- --------------- --------- <br /> I hereby certify that repared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws and regulations of the San Joaquin Local Health District. <br /> (Signed)----------:---- -- ----- --- -------- - -----------------•-------------------- and/or Contractor) <br /> By.______i_________ _____________________ ___{__...__�_.__e- �- <br /> ._____.___. ____.:_.__--__._______.___.._____'(Tttle)_..._.______'.T.._ � ._.__.__.- — "(Plot plan, showing size of lot, location of sysfion t ells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 41 <br /> APPLICATION ACCEPTED ------ DATE-- <br /> REVIEWEDBY----- --------------------------------------- ------------------------------------------------------------------------------- DATE---- <br /> BUILDING PERMIT ISSUED-------- -- ----------------------------------------------------------------------------------------._ DATE------- - -------------------------- ------------------- <br /> Alterations and/or recommendations:-------- ----- ------- ------------------------------------------------------------- -----------•----------------- -•---------- <br /> eell <br /> FINAL INSPECTION BY: /tf ---------- Date -.^_it'_ .. _ .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Hazelton Ave. 300 West Oak Street v 124 Sycamore Street 205 West 9th Street <br /> Slocklon,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />