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FOR OFFICE USE: <br /> --- -------------- ---------------------------- <br /> ---- --------------- <br /> -------- APPLICATION FOR SANITATION PERMIT Permit No. _. � .__ <br /> ---------------------------------------- <br /> --- --- --- (Complete in Duplicate) �- <br /> ! _ Date Issued --!------------��- ._�� <br /> ___-----_----------_------------------------------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrGc n install the work herein described. ` <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_ ►►-tyc_ --Y _ --------------- <br /> - <br /> / .. <br /> Owner's Name----.// 1-s• r*�-_.+_°-----------•-•---. ---- -.Phone.-....---•-_---------------------- <br /> Address /.._:..� 'A. ------- i----- <br /> Contractor's. Name- -Al <br /> s - .-----/4�40 -------- ---------• -------------------------------------------------------- Phone------------------................ <br /> Installation will serves 4Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _l__-___ Number of bedrooms A--- Number of baths __7!�-_ Lot size _________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private N Depth to Water Table 1_P__ ft. t a <br /> F <br /> Character of soil to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ;0 Clay ❑ Adobe ❑ Hardpan ] <br /> Previous Application Made: (If yes,date-- .--_-_---._._) No New-Construction: Yes No ❑ 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 /> Septic Tank: Distance from nearest well_-_______- <br /> _ Distac9 <br /> --f-r--o--m-- foundation <br /> -o�-�-u--n-dation-_ZA--.._._.--M _ `�'�[------------------------------------ <br /> No. of_compartments---'r . -----._._{Size--� ---- q P. -- p Y4- - -----�V\ <br /> -- <br /> Disposal Field: Distance from nearest well.�'e.----------Distance from foundationA�-------------Distance to nearest lot line_f a____.___.. <br /> Number of lines------- --------------------------Length of each line------ _____.--------------Width offrench---P�-''-_'/_____-________.___. <br /> yp �G ___Depth of filter material--------L-q ---------- length_�rr0__________________ ___________ <br /> ,. ",T e of filter materia_.__ . V <br /> Seepage Pit: Distance to nearest_well_4!v7R------_______Distance from foundation-_Z0-_______._.Distance to nearest lot line---/A_._I-,' , <br /> Number of pits-_______________Lining material_��_,- Size: Diameter.!._---!�.�6p sarest well_______________Distance from foundation__._:,_____..-__-.-.Lining material__.:,.__...--_--.-..---.__ ----Cess o01: Distance from n t - De th---------------------------------------- -Li uid Ca acit � ----Size: Diameter----- -------------- - - <br /> Distance from nearest buildinPrivy:. .. Distance from nearest well--------- ------------- ----- ------- - -- - g------------- - ------------ <br /> ❑ Distance to nearest lot line------------------------------------ ----- -- - -------------------------------------- <br /> Remodeling <br /> ------------•----------------------Remodeling and/oF repairing (describe)---- <br /> ----------- ----------------r <br /> r� - i <br /> 16 <br /> ----------------------------------------•------------ --------- -•----------------------------•-----------•---•------:-------------------------------------•------------------------------------------------------------------ <br /> f <br /> --------------------------------------------------------_---------------------------------------------------------------------------------------------_________ _-_-__--_--__-__._-___---.-..__.. <br /> -_____-- --------------------- -----------------------I-_________. -----------------------------------------------.-_----------------------------------------------______----_----- i <br /> I hereby certif that l have prepared i0pplicati6n and that the work will be done in accordance with San Joaquin County <br /> ordinances, St tows. <br /> and rules and:r tions of t�n Joaquin Local Health District. <br /> (Signed) l - _ (Owner and/or Contractor) <br /> By: --- --------------------- --------------------------- ----------------------------------------------- --------(Title)---------------------------------------- -- ------- -- -------- <br /> (Plot plan, showing� fo , location-of system in relation to wells, buildings, etc., can be,placed on reverse side). <br /> FOR DEPARTMENT USE ONLY, <br /> APPLICATION ACCEPTED BY- - ------ - - -------------------------------------------------------------------- DATE-/a--'�o--------.------- <br /> ----------------------- <br /> REVIEWEDBY----'---------`---------------------------- -- -----------------I- ---------------------------------------------------------- DATE-----------:---------- - <br /> BUILDING PERMIT ISSUED-------------- -------------------------•------------------------- -DATE. <br /> _ i <br /> Alterations and/or recommendations:--------------- --------------------------------------------------------- -----------•------•------------------------------------------------------- i <br /> - 1 <br /> -----------------------------------------------------------------=---------I--------- --------------------------------------------------------- -------- ---------------------------------------------------------------- <br /> t <br /> ------------------------------- -------------------------------------------------------------------------------------------------------- ---------- -----•----------------------------------------------- <br /> ----- ------ --- ---- -- ----•------- ---------------------------------------- ---------- •--------- ------------------------------------------ ---------------------- ---------- <br /> � I <br /> FINAL INSPECTION BYE---------------------------------- Date--.1,2-' 'n -63----- -------- E <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVl6EP B-59 3M 3-'63 F.RC0. <br /> 1 <br />