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APPLICATION FOR SANITATION PERMIT Permit No. --9-.---------- <br /> Duplicate)(Complete in Dup ) Date Issued <br /> q <br /> Applica'•ion is hereby made to the <br /> San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County O dinan e No. 549. <br /> �f <br /> � /� nry <br /> ------------------------- <br /> -- - <br /> JOB Ax +F " f Pho <br /> - ------------ ------------ <br /> -------- <br /> Owner's Name------ _ -- -- --- <br /> -------- <br /> Address _ ----------- <br /> 6_______.__ <br /> ----------•--- <br /> _ -- ----------------•--- <br /> Contractor's Name----_------ ------ --- ----- ------------------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Othej <br /> rh / <br /> Number of living units: __d_._ umber of bedrooms .: " Number of baths _-I---- Lot size r <br /> Water Supply: Public.system Vommunity system ❑ Private ❑ Depth to Water Table _-______ <br /> Loam Clay Adobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay ❑ Y ❑ <br /> ' ation Made: Yes No W New Construction: Yes No ❑ <br /> Previous Application ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , <br /> (No septic tank or cesspool permitted if u is stwe t is available within 200 feeett}.1f <br /> Vic <br /> fro faundati n_,/VMaterial----_/-'------'--- --J-- - <br /> Septic nk: Distance from nearest we �'-- -- p <br /> No. of compartments----------_74_-� -`Six zppc - '-" a - . `iquiid qep h_ --_Capacity �Q <br /> Field: Distance from near st well`�?' �stance rom.foun at•o'"-(;O_=fir"'--Des#ante to nearest lot jir�e----. --, ' <br /> Disposal y�/11J 1� 1�`+b__'--.Width of trench_. -_ <br /> Number of lines_____________ Length of each ine___-�___�__ jt <br /> ! / <br /> .� Type of fel a#enal� " "-- -�--""_-- pth of Iter mater- I__j�_-`-�-W- i <br /> ---Vt nre� pa Pit: Distant t ne re ll_.. -" an r o ti�;;Number ening materia lame <br /> I1t Cesspool: � Distance from nearest weld_______________ Distance from foundation-_.._____,..___.._.Lin'siig'material-------.----------------•--------- <br /> als. <br /> 1 . ❑ Size: Diameter -- ------Depth-------------- =--- ------------------------ ----Liquid Capacity----•-----------------------9 <br /> Privy: Distance from nearest well____."._---------------- <br /> Distance from nearest building-------------"---------------------------- <br /> ❑ Distance to,nearest lot line----------------- ------------ ---------------- ---------- ----------------------------------------------- <br /> = r y = <br /> Remodeling an or epair'n (describe) _ ---- ----- <br /> •--- . <br /> ' -- ' <br /> --•---- ------- �C <br /> 1 - <br /> i ; !►.a. - --------------- <br /> --------------------------------------------------------------------•------------------------------•---------- <br /> # I hereby-certify that I have prepared this'application and that the work will be,done in accordance with San Joaquin County <br /> ordinances, a /11aw , and rules and regulations of the San Joaquin Local Health District. <br /> (Owner and/or Contractorl <br /> Si ned( g )------ - ---- -- <br /> (Title) <br /> By:----------- - ------ -----buil buildings, <br /> pian, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> 4 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___ --- ------------------------ <br /> ----- ----------------------------- DATE__ -----•---••------- -------------------------------- <br /> ' DATE__ X <br /> BY--------------------------------- --- -- ----------- ----- ---------------------•---------------------------------- <br /> BUILDING PERMIT ISSUED----- - <br /> ------ D.ATE.----- �F-------------------------------------------- <br /> Alterations and/or recommendations <br /> . recommendations:___-- <br /> ------- <br /> ---• <br /> - -" <br /> -------------- ------------------ <br /> ------ <br /> ------------------ ------------------­------------------------- <br /> ---- -------- -------... <br /> --------------"--------------- - ----------- -- <br /> t <br /> 74-11 <br /> ------r - ---- -- T - -- ----- ------" ...... <br /> _______________i___"-----_.______. Y <br /> _________________________________"____".______ <br /> _ ____ <br /> _ ___- __ _ ___-----------________________________"--_.__ _____ _"". <br /> ----- Date--- --- --- ---- <br /> --- ------- - - -- <br /> -------------- --------- <br /> FINAL INSPECTION- BY:--------------- -----•---------------------------- <br /> - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Streat 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street Trac CaliforniaStockton. California Lodi, California Manteca, California Y. <br /> cc <br /> 0 ')kA P-;-4 4 W-7100 <br />