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_J/�F41Z OF. USV <br /> 2 <br /> -----------;,_ � <br /> ION FOR SANITATION PERMIT Permit No. <br /> . ........ ------ - -- -- ....... <br /> --------------------- <br /> (Complete in Duplicate) q <br /> This Permit Expires I Year From Date Issued Date Issued <br /> ........................ <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 /> Nr) LOCATION..., -------- <br /> JOB ADDRESS A ------ -------------. ................_..................................... <br /> 6-57_',-2Z---- <br /> Owner's Name.... 4-i(_......... ----------------------------------------------------------------------------------------------- Phone..................•................. <br /> Address------...,........... ...... <br /> C. ----------- <br /> 2 -------- <br /> ' <br /> Contractor's Nane_.. Ph0 . .7......................... <br /> Installation will serve: Residence Apartment House E]_ Commercial [] Trailer Court C1 Motel 0 Other C] <br /> Number of living units: Number of bedroomGL. Number of baths _/. Lot size .//.41 ..................... <br /> Water Supply: Public syitem El Community system 0 Private Depth to Water Table S.-P ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam E] Clay Loam E] Clay [-] Adobe%r Hardpan ❑ <br /> Previous Application Made': -(If yes,date--------------- -_) No ❑ Now Construction: Yes El Noo FHA%VA: Yes [] No ❑ <br /> TYPE OF INSTALLATION ANDS, PECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> iDistance from nearest well.................Distance from foundation....................Material... _--_-_-_---------_------ <br /> c <br /> k:_ Distance <br /> of compartments__---------------_--Size................................Liquid depfh..........................Capacity....................... <br /> ?i,po,al FiTed- Distance from nearest Distance from foundation._Z..�._..10.....Distance to nearest ]of line__ '__.....IF <br /> ............ <br /> Vr Number of lines.. . Length.of each J.......Width of trench...... ZI;..................... <br /> ------ <br /> Type of filter ma __PAO�4__Depth of filter ........Total length______________________-------' <br /> Seepape Pit: Distance to nearest ........Distnc f f ndatlon_A�_:_Q........Di,tanp ... <br /> to nearest lot line... ...... <br /> Number of pits--.____-_-__--__--Lining material., 4T ...Size. Diameter._3-1.---------Depth....__. ................ <br /> Cesspool: Distance fi-orn nearest well.................Distance from foundation....................Lining material.............__.........._..___._.... Uj <br /> El Size: Diameter.....................................Dept h.............................----_------ -----.-Liquid Capacity...................._.....gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building...........--.__.__.__.._..___...._._... <br /> ❑ Distance <br /> uilding......... ------------_-------_--- <br /> Distanceto nearest lot line....-- -•-•. ...............................................................................................__---------------------------- <br /> Remodeling and/or repairing (.describe):............ ............................................_.................................. ............................................... <br /> ........................................................................................................I...................................................................­................... <br /> ­- — ­ _-•••.............................................................................................I--......._........................................................................................... <br /> -­----------------------------------------------------------------------------------------.............................................................................................................................. <br /> I hereb�ce, i,� that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances e laws, an rulesii�id regulations of the San Joaquin Local Health District. <br /> .. - --------- ------------------ ----------------------------------------------------------------- Owner and/or Contractor) <br /> (Signed)...... .. ........... ------ <br /> -------------------------------------------- <br /> By ...................... Z4 Arifle)------- <br /> a reverse--- ----*..... ...... --- --- <br /> (Plot plan, showing size of lot, location of system i e6ficin to wells, buildings, etc., can be placed on reverse side). <br /> FOR,PEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY __. .......................... DATE___-_-_- ................... <br /> REVIEWEDBY......... ........... .............................. .......................................................................... DATE.................. --------------- .................... <br /> BUILDINGPERMIT ISSUED........................................ .................. DAIE------------------------------------- -----_------_------- <br /> Alterations and/or recommendation ............................................................ <br /> <.... <br /> ... <br /> . ...........6 _7........................ <br /> .................................................I................................... -------------------- ---------------------- ----------------------------------------------------------------------------- <br /> .......................................................................... ......... <br /> . . .................... .......................................................... <br /> .................................................................................... .... ..................................... ..................................... .......................................... <br /> FINAL INSPECTION BY:. N_�. 1_�A'l <br /> ..................r-___-----------•--- Date......... ................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Vocklon,California Lodi,California Manteca,ColiFornia Tracy,California <br /> ES 9 REVISED 2-59 2M 3-'63 F.P.CD. <br />