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FOR OFFICE USE: <br /> 2/1 ;Z ........................... <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..... <br /> -- -------------- <br /> .............­ . (Complete in Duplicate), <br /> ...................... .............. Date Issued ..Z10A1_ S <br /> .............. .. This Permit Expires I Year From Date Issued <br /> .. ......... ....I_—........ <br /> Appllicafion 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....---..4 .......... ....... <br /> Owner's Name................. ............ <br /> ........------- Phone.//,a.. <br /> Address <br /> _,F------------.................................................................................. <br /> ----_--------------_-----pla ------ <br /> 46 <br /> .-,. <br /> Contractor's Name.-.,, 1124-e-L�... <br /> 7­ <br /> Phone. <br /> Installation will serve: Residence X Apartment House ❑ Commercial [] Trailer Court [3 Motel F1 Other El <br /> Number of living units: _-.I... Number of bedrooms A. Number of baths l.... Lot size ........_.._€6-- --- ......... <br /> Water Supply: Public system El Community system [3 Private X Depth to Water Table 40. ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam;k Clay Loam [I Clay E] Adobe 0 Hardpan 0 <br /> Previous Application Made: jif yes,date..-_.__.. _.._No New Construction: Yeso No FHA/VA:Yes O- No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .(No sapfic-tink or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept;c Tank: Distance from nearest well-----------------Distance from foundation.........._..-......Material...._...........__........_..........._._...----. <br /> ❑ fXlSi/AtF3 <br /> aterial.................................... ---------- <br /> Z.,e1_5;-1Atj3 No. of compartmenis-. ------------- Size............................---Liquid depjh...........................Capacity.................. <br /> Disposal Field: Distance from nearest well---44RV_Distance from foundation.... -_---Distance to nearest lot line.. <br /> b;e1-Sr11t-r.Number of lines•.............___ ......Length of each ...Width of trench...... ........ <br /> ---------•---- <br /> -09d/ Type of filter materiai._t .... ............Total length....... )j <br /> Depth of filter material. <br /> . <br /> Seepage Pit: Distance to nearest ...... from foundation---e. .........Distance Dis ance <br /> iine <br /> Number of pifs......../_........Lining ''Mate r;1aI._A1,ee4ejK. 43 <br /> S:ze: Diameter.. .�a... to nearest lot.........Depth.....02.S.............. <br /> Cesspool: Distance from nearest well............... Distanc <br /> "efrom foundation............*­_....Lining material._.................._-_............... <br /> . <br /> Size: Diameter_.......___ h <br /> _.........................Dept '-..., <br /> 11 ...........................-••----------Liquid Capacity............................gals.--j— <br /> Privy: Distance from nearest well..........................._..._.......'::.....__Distance from nearest building__............._--._.------ . ........ 0 <br /> El Distance to nearest lot line.......-------- --------------------- ................. ......................................•..._................ <br /> 4 r-1 <br /> Remodeling and/or repairing (describe)%..." ----7*7e.. ......--------•••-•-•••-•••-------•• <br /> ..............................I......................................... .................................. ....................---_------- ........................................................ <br /> ..........................................................................................................................................................------------------------.................­................ <br /> ...................­.................................................. <br /> -----------------------------------.............................................-------------------------------­-----------................. <br /> I hereby.certify that I have prepared this application and that+he work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules nand regulations of the San Joaquin Local Health District. <br /> ­­---- .........-------- ------------_.............(OwnP4 and/or Contractor) <br /> (Signed)----------- <br /> .......(ritle).......I? ........ --------- <br /> By:............. ----------------------------------- <br /> i'4i, location in relation buildings, etc., can be placed on reverse side). <br /> 0 <br /> (Plot plan, showing $;:,',e a o iocai; system ior� +a wells, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY .................................................................. DATE----0. ..(9-A---------------------------- <br /> REVIEWEDBY_...--------------------------- .................. -- ----------------_ ------- --------------------------------- ---- DATE. .1. ..................................................... <br /> BUILDING PERMIT ISSUED.......... -__--------------------- - ..........­ DATE--- -------------------------------- -----------------; <br /> ................................... ---? <br /> Alterations and/or.recommendations:..i.t.t..1.7..!..�P-61;......E_...... ------ . <br /> ..0. <br /> .......................................... ... <br /> ....................... ......1-.........................................................__..................................-•-•••......••...... <br /> .......................................................................................I..................................................................................................................................... <br /> ..........*........... ...................................................:....-•----•-•....... .......------.........•...--................-•--••............... .............................................. <br /> ............................................................................................ .....................................................---------............... ..................................... <br /> FINAL INSPECTION BY:---- ....................... ......... ------(1-'.-I!i�'. ( ........................... <br /> Date ----­-I................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9fh Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED ft-S9 3M 3-63 F.P.CQ- <br />