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FOR OFFICE//USE: <br /> y/ C--------- - 7 <br /> -fl <br /> �, _� ,_ APPLICATION FOR SANITATION PERMIT Permit No. _._�.........._�--_-- <br /> -------------------------------- -------- ----------- -- (Complete in Duplicate) <br /> --------------------------------------------------- <br /> This Permit Expires 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 described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..._ -----. --•-----•------------------------------------------------ <br /> Owner's Name------- p ---------------•----------- ------------------------------------ <br /> Address__ <br /> ------------------ Ph.. ... --_ <br /> Address.-_------_--------•---49� �i - � -- <br /> ey <br /> Contractor's Name. {'` '` -/Z �f----/......•..------ Phonal/e�-.. '" �� . <br /> Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _�_--- Number of bedrooms __? Number of baths�W Lot size ------- ............. _--..----._ <br /> Water Supply: Public system 54—Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ NoL-JE�` 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 /> tiC <br /> J ?I <br /> Distance from nearest well------_--------_Distance from foundation__..--------.------Material------------------------------------------------- <br /> No. of compartments--------------------------Size-------------------------------Liquid depth---------- --- ----------Capacity....------------------- <br /> Distance from nearest well-1'1`P •--.-Distance from foundation...-_I- .r-.Distance to nearest lot line-----_ ..... <br /> Number of lines___-_- -_ -.__--- -_ Length of each line-------�-Q-'-------.Width of trench-.-.--- -.5�'--------.---- <br /> 1 Type of filter material-_ _D(----_-Depth of filter material-----/�'----__-Total length---------.-,�..Q-'------------------- <br /> page Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-.------------. O <br /> [] Number of pits----------------------Lining material-----------------------Size: Diameter--------------..-------Dept h--------------------.--•-----••-- p . <br /> Cesspool- Distance from nearest well-----------------Distance from foundation---.----------------Lining material-------------------------------------- <br /> El <br /> ------- __--------❑ Size: Diameter------------------------------- ------Depth----------------------------------------------------Liquid Capacity--------------•----------•--gals. <br /> Privy: Distance from riparest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line---------------------------------------------------------------------- ------------•-----------------------------------•----------------- <br /> Remodelingand/or repairing (describe):----------- ---------------------------------------•--- ------------- - ------------------ ----------•-------•--------•--•----_-------------•--- <br /> -----•--------------------------------------------------------- -------- --- --------------- '--------- ----------------------- -- --- ---- ----- --- --�----•--•--------------------- ------ <br /> ------------------------------------------------------------ ---- --- - -- ----- --•--------•----------�---- -- ---- ------• l/ ------------------- <br /> ' ------------------------- --- <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, State laws,�and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ✓ -------------------- Contractor) <br /> a� r� <br /> --- - ---------------------------- <br /> BY6EPTIG T-,-MK--6ERVIei=-----•------------------------------ ----- ------------ --------- (Title) <br /> (Plat plan?9A*i4@ndt6%&LhffPl041 " of system in relatio o wells, buildings etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- --- ----- -------------- ----------------------------- -- ---- DATE--------- 3C� (Q ---------------------- <br /> REVIEWEDBY-------------------------------------------- - -----•------------- ---------------------------------------------- •----- DATE--------••--•-•---------••-•-------------------------------- <br /> BUILDING PERMIT ISSUED------•----------- ----------- -----------------------•-___------------------ DATE <br /> Alterationsand/or recommendations--------------- -----------------------------------------------------------•-•------------•-----•-------•-----------_---....--•---•------•---------------•--- <br /> --- c.� Cao ------------------------ <br /> ---••------------------ <br /> /P------------Tff..-/� �c i r.-sem:/lac C -� -•------------------------- -- <br /> FINAL INSPECTION BY:.. F_ --------- -------------- Date----- ----------------- -------------------------•------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad],California Manteca,California Tracy,California <br /> E6.9 R(ViME13 13.59 F.P.CG,1M 6-60 <br />