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FOR OFFIC <br /> SEX <br /> NO---------- _ <br /> _.._________________ __ APPLICATION FOR SANITATION PERMIT Permit No. ..l__��..�� <br />--------------•------------- --- --------------- __ (Complete to Duplicate) '71 ` <br /> . � <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 end install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOC. ------TION.__.•. ----------------- ------ <br /> Owner's <br /> -----Owner's Name______________ -�-••-----�/-•- �--'-- �- =----•.-�.--.�-�-- .-,-�•--_-_-x-_--+-�------rt•-- <br /> ----------------------------------•--------------------------•-------••------------ Ph�one---- <br /> Address.............._-----` 3 <br /> ---Address------•---•---- ----` 3 C � <br /> Contractor's Name 4hx-v ----------------..................................... Phone................................... <br /> - <br /> • <br /> Residence <br /> Installation will serve: Apartment Ho ' <br /> �' p use ❑ Commercial C] Trailer Court E] Motel C:1 Other [:1 <br /> Number of living units: -.4 Number of bedrooms ___'Number of baths .../... Lot size ----�__ _.X..l------I. ......................... <br /> Water Supply: Publics stem Community system Private Depth To Water Table ft. �f <br /> PPY� Y ® Y Y ❑ ❑ P <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 51 Clay f@ Adobe® Hardpan ❑ <br /> Previous Application Made: (If yes,dote,3jfz`3_-) No • New Construction: YesigW No ja FHA/VA: Yes ❑ NoJX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: \�' �-"•'� 1�6_ /.t—r,f—j - • <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> - t <br /> Segtic Ta s ,-a Distance from nearest well_________________Distance from foundation--------------------Material______-.-_-_______.___..-------____.___--___-___. <br /> �� �' No. of compartments--------------- •---------Size----------------------2,...Liquid,depth--------------------------Capacity---------------_------ <br /> D`isposal Field: Distance from nearest well___------Distance from -foundation.._...._'Z _`Distance to nearest lot line........... <br /> ® Number of lines--------------�-----------------Length of each-line----------Pte......... Width of trench.----3 --- ---------_------- <br /> Type of filter material._. _� 1..-._.__Depth of filter material..... lS`_� -.-Total length.....Pa____________________________ <br /> Seepage.Pit: Distance to nearest well------!--Distance f m foundation----t/o _-.Distance to nearest lot <br /> Number of pits-------/--_----_____Lining material.---y_;F6X----Size: Diamefer----...?3.....____.Depth------X6—V <br /> ----- <br /> "—Y <br /> Cesspool: Distance from nearest well---------------__Distance from foundation--------------------Lining material,_._____.._.--______._______......... <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity----•---_-----------------gals. <br /> Privy: Distance from nearest well------------------------------_----------_-------Distancoe from nearest building----------...___-________-__________--. <br /> ❑ Distance to nearest lot line---------------------- ---------------------- <br /> ---------------------- <br /> Remodeling and <br /> ' or repairing (describe:--------- ----------------••----- �- cJ � �` .._.. <br /> --- <br /> ` � � ....__. �• �� = "------------------------------------------------.--------------------------------- <br /> ----------------------------------------- •--- <br /> ---•- <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)...•-•--------------------- --------­­ --------------- ------------ ----------- f---------------------------------------------(Owner and/or Contractor] <br /> --- "_ �P-y-�+-----(,tie) <br /> By,... --- <br /> (Plot pian, showing si of lot, locati system in refs n tows s; buildings, etc., can be placed on reverse side). <br /> F EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- --- <br /> ------------------------- ----------- DATE----------- <br /> REVIEWED BY .... --------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED k-- :::: ------------ --------- DATE------------------------------------------------------------- <br /> Alte�r i_o�nss and/or recommendations:---------------------- -------------------------------------------------------•-•---------------••-------------•----------- --------------------------- <br /> f`f �`'3'= ,�• ^-� `�' -----�.�------------•-------••----------------------- <br /> --------------------------------• •-•-------------••-------.. ----------------------------------- ---------- ------------------------------------------------------------------------------------...------------........ <br /> --•----------------•---------------- ---- ---------•------ ------------- ---- ----- ----- ----------------•- -------------------_------------------•-- --•----------------------------•- -----------------•--- ------ + <br /> FINAL INSPECTION BY:........... ----------------------------------------------- <br /> SAN <br /> _.----... _ ` ------------- bate----------,� <br /> ------- ------•--- �dJ `� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street + , 124 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California r Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />