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FOR OFFICE USE: <br /> ................... -------- ----------­................ <br /> .................................................. APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------------------------------------------- ....... (Complete in Duplicate) Date Issued la- -6.2— <br /> ......................................................... This Permit Expires Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal]the work herein described. <br /> This <br /> application is made <br /> in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION::Ofire�Y1vt�t ✓t d:: .j !....� ----------9......... <br /> Owner's Name...,YIAA-4& ---- <br /> IV-41---------------- --------------------------------------------------.........------------------ Phone............-------------------- <br /> Address_j?]...... ... . .... I--- ---- ---------- ---------------- ... ............................................................................................--------- <br /> ....... .. <br /> Contractor's Name---------- .. ..... ....... ................. ❑....... ... ........................................................ Phone................................... <br /> Installation Will serve: Residence X Apartment House [3 Commercial E] Trailer Couit El Motel ❑ Other 0 <br /> Number of living units: Number of bedrooms.2.. Number of baths .1..... Lot size . <br /> C] -------- <br /> Wafer Supply: Public,system Community system ❑ Private Depth to Water Table;r6 <br /> 'K - <br /> Character of soil to a Aepth of 3 feet: Sand E] Gravel El Sandy Loam X Clay Loam El Clay,-K Adobe❑ Hardpan C-] <br /> Previous Application Made: (If yes,clate---------------------) No-4:14 Now Construction: Yes No ❑ FHA/VA.- Yes 0 N <br /> OA <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic.tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank: .,Distance from nearest w Dista f f dat*,on___.1_0_._ M t I <br /> ... .............A <br /> _ue rorp oun ------ ...... <br /> PR No*. of compartments.. ----_-----------Si,e,"-X'fD...........Liquid del . ...... <br /> Disposal Field: Distance from nearest Distance from founclation....1.0.........Distance to nearest lot line.----."t. <br /> - ---------- <br /> e/ <br /> ------- Width of ftench._07_��................... <br /> Number of lines. ------__ ...Length of each line---I_rb n L' ­ <br /> Type of filter material Depth of filter materiaI____,A_7—-----:---Total length .......................• <br /> Seepage <br /> ... -----------_-- <br /> Siiepage Pit: Distance to nearest wall____6.PP..--.Disf,,nlce..from.fToUfi'd=i n---JAL— Distanc;,to nearest lot lin ............ <br /> n <br /> Number of pits....................Lining materia 101`!� meter---------?1I__21_7'._'_Depfh__----A-7_-______....... <br /> Cesspool: Distance from nearest well.................Distance from fdundation----------------:_Lining material........... <br /> ❑ Size: Diameter-------------------------------------Depth--------------------------------------------------- Liquid Capacity......... ................gals. <br /> Privy-- "Distancei from nearest well.................................................Distance from nearest building...__.___..__.._._..................._.... <br /> 0 Distance to nearest lot line............................................................................................................................................. <br /> Remodelingand/or repairing idescribe):......................................................................................................................................................... <br /> .......................-------------.................... ......................................:.............I...........I——.............................................................I......................... <br /> . ......................................................................................................--------------.......................................................................................................... <br /> ,ate <br /> ............................................................................................................................--------------------------------------------------------------------------------............... <br /> I hereby certify that I have prep9red this application and that the Work-will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rples and regullalions of the San .Joaquin Local Health District. <br /> (Signed).................. -Con ac r <br /> ---~I - -_ --.:------------ .. ............................................... fr to ) <br /> By:........................................... , 1 4..) <br /> ....................... . ...................(Titie) --- .... <br /> buil <br /> IP6+ plan, showing size Of lot, location of sysfe i relation f�a�welsl ings,,qfc., can 6s'placed an reverse side). <br /> FORDEPARTMENTUSE'ONLY <br /> APPLICATION ACCEPTED BY----------------------------------- "".-----+ - -------------......... DATE--------------------- ----------------- ................ <br /> REVIEWEDBY............-_---------------------------­*................................. e.n�............--1... DATE...... ................... <br /> BUILDING PERMIT ISSUED._.. i <br /> ......J............................ D,&TE_--------------------------------------------------------- <br /> A*era+ions and/or recommendations:._-:.:.......... .............. ............................-------:----------................................................................ <br /> ................:­............................................... --------------------------------------------------------------------------------------------------------I.............................................. <br /> ....................................................................... ------------------------------- -------------------------------------------------------------------................................................ <br /> .............--------------;..........................................._.......................................................................................................---------------------------------- <br /> ........................ .............. . ...................... ----------------------........................................................................................... ............... <br /> FINAL INSPECTION BY:....... . ..... .........._----- Date......... <br /> . ... ..................................................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West CIA Sweet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Ell 9 REVISED 8.59 11M 11-61.AILAS <br />