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rUK ul-rlt : ubt: �I <br /> ----------- ------------------------------ <br /> -------------- <br /> ---------------------- - <br /> !'_- APPLICATION FOR -SANITATION PERMIT Permit No. .ry�__637c; 011' <br /> ---------------------------- --------- -- ------ (Complete in Duplicate) <br /> ----------- ---- --- Is This Permit Ex fres 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and,install the work herein desc ibed. <br /> This application is made in compliance with County Ordinance No. 549. ^ - lez / <br /> JOB ADDRESS A LOCATE N. • <br /> I <br /> I <br /> -. .q- -- <br /> F Owners Name_______ •��-'-- ___ <br /> ----- Phone- <br /> ------ <br /> C --- ------------ --------- <br /> Address-------------------- ----- C�f7.7C------- _ <br /> I <br /> sta -• l <br /> Contractor's Name-- �' .. <br /> ----- �---------- �,. .°3 Phone-.- . <br /> Installation will serve: Residence Apartment House ❑ Commercial <br /> ❑ Trailer Court [[ Motel ❑ Other ❑ ' <br /> r Number of living units: ---�._ Number of bedrooms _ <br /> ! umber of s ---/_ Lot size --- ' <br /> Water Supply: PublicCommunity❑ Community system ❑ Private Depth to Water Table dit. <br /> Character of soil to a depth;of,3.feet: Sand ❑ Gravel ❑ Sand Loam ClayLoam Clay <br /> � z <br /> v Y ❑ ❑ y ❑ Adobe Hardpan ❑ <br /> 1 Previous Application Made: `(If yes date.-_.___--_ - _ - _- <br /> it - �- l No ❑ New Construction: Yes ❑ No' FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> f,r ^?! (No septic tank 3or cesspool permitted if public sewer is available within 200 feet.) <br /> Distancei�from nearest well------------- __Distance from foundation________________ <br /> Material-------- <br /> No. <br /> s. of compartments--------•-----------------Size- <br /> `4 „ Liquid depth -- - Capacity <br /> +s I Id. Distance;'from nearest well-.__-_-----------Distance from foundation---_--.--.-- -.--Distance fio nearest lot line_---_--'.._-___- <br /> w Number of lines------------- _-.-Length of each line---------- <br /> r°' Width of <br /> � trench--- ----- ------ --- <br /> --- rTYPe of finer material_-- Depth of filter material-----------------,--.Total <br /> length--------.---------------------- <br /> +- -- <br /> See a e Pit: Distance to nears t well._. .-- _- <br /> Distanc from foundation---•. rw r <br /> _-----.-.DistancQQ to nearest <br /> "" Number of pits__--_-.-__--- Lining material O. <br /> i �_ Size: Diameter_-- ----Depth_- _----------------- <br /> Cesspool: Distanc`e4rom nearest well _._ Distance from foundation.__._..___ <br /> M ---------.Lining material----- ---------------------`-------- <br /> ❑ Size: Diameter------- --------------------:__ -- <br /> ------Depth----------------------------------- - -------------Liquid CapacitY +gals. <br /> ' <br /> Privy: <br /> from nearest well <br /> --- -----------------�_,_------------,_ Distance from nearest buildin <br /> Distance f <br /> o nearest lot line..............___ _ ____ _ -- <br /> Remodeling and/or repairin --r�r <br /> g [describe):_--_ ''i__ � •, <br /> a - <br /> --- <br /> ---------------------------------- -- Il jy <br /> !r <br /> ---------------------------- <br /> ------- -----------------------`--------=------------------------------------- __'' <br /> . - * g <br /> -------------------------=----------------- ----------------- <br /> I hereby certify that 1 have prepared this application and that the work will be done,in accordance with San Joaquin County <br /> ordinances, St I s, and rule and,re ulati s of the $ Joaquin Local ealth District. •., <br /> (Signe - -=- ----- \ <br /> ----- - ---- -- - ---- ------- ------------------ ontractor] <br /> .By:--------------------- ------ 11 Title) 1 <br /> (Plot plan, showing size of lot,'ilocation of system in relation to w , buildings, et can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> r , <br /> APPLICATION ACCEPTED BY_ � -,---. -_-_ ,�` <br /> DATE - - ---` -- -------------------- <br /> ----REVIEWED BY ------- ------------------------------ I <br /> -- -------- ----------- --------------------------- --------- DATE----- ------------------------ <br /> BUILDING PERMIT ISSUED---'' <br /> Alterations and/or recommendations:_ -%-------------------------------- ---------------------------. DATE---------------------------- <br /> - ------- ----------------- <br /> -----------------------------------•------------------------------ <br /> ------------------------------- <br /> ----- <br /> -- <br /> -------------- ------- <br /> ---- ------ <br /> 4h. <br /> FINAL INSPECTION BY <br /> .�, - ” sDate-_� "� <br /> II <br /> ! SAN JOAQUIN LOCAL HEALTH DISTRICT # <br /> I- f <br /> 1401 E,Haselton Ave. 300 West Oak Street { <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> h ! <br />