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FOR OFFICE USE: <br /> ' --------------- Permit Nle <br /> APPLICATION FOR SANITATION PERMIT °• ` -- ------•--- <br /> (Complete-in Duplicate) <br /> "------------------ --------- Date Issued <br /> - This Permit Expires 1 Year From Date Issued r '" <br /> --- -- ----- --" -- - ---- --- - ---"---' -- _ t�2,� --130 —o� , <br /> Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> ��o� ����� � y Ordinance No. 549. ' <br /> w�� <br /> -. . ` IZ�f----------This a Gcation isAmade 1CATIONn. wi ounJOB ADDRESS �__e <br /> _ <br /> Owner's Name.--- <br /> 2 <br /> ame.-- f} <br /> -•-'tri..-• ----- ---- -- - - - -------•---•----•----------- <br /> -_ .A_ Ph nem <br /> t ................__._.. -------- _._..............___........ <br /> Address . -.__ �' <br /> 1,. . .. <br /> Con#ractor's Name <br /> ------ Phone------.-------------------- - <br /> Motel Other <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Cour# ❑ ❑ y ❑ _ <br /> Number of bedrooms _....._- Number f baths...�.__ Lot size <br /> 1 <br /> Number of living units: __ ----- ------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .....- - ft <br /> i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam U!r Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date----------- ----- 1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1�II. <br /> from nearest well... : ..._-.DistaDistance from ------ <br /> - <br /> Se #ic ank: Distances apacity.. - <br /> No. of compartments-- - Size.- (-Y' fq p. C <br /> -------------- <br /> v1 <br /> ��"- -- <br /> Dispos; Field: Distance from nearest well_.✓..@ ......Distance from foundation. -IP........_. Distance to nearest lot Iina_t.P... ._.... <br /> Number of lines.------------ -- ----- Length of each line-- ---�d- ---'---------Width of trench...... ....- <br /> �� / <br /> Type of filter material---------S. ._ -------Depth of filter material------�g..._...._Total tang+h....__ D--- <br /> Type <br /> Seepage Pit: Distance to nearest well............... ...Distance from foundation----.--------------Distance to nearest lot line----------------- <br /> 0 Number of pits--- ------------------Lining material---------- - ------. Size: Diameter- -=------------- - Depth--.-- ------------------------- <br /> Cesspool: Distance from nearest well . .............Distance from foundation____...._._.. _.Lining material.._.........-__.....'---------------- <br /> 6a <br /> _-...._.--- -- , <br /> ❑ Size: Diameter- ------ -- -- --------------- Depth----- --------------------------------------------Uqui/Capacity- ' ------------------ -----gals. <br /> Privy: Distance from nearest well-------------------------------------............Distance from nearest building____--.....___.._...-------------..------. <br /> ❑ Distance to nearest-lot line ---------'--------------- - - -- ---------.._--------------------------------- ----------------------------------------- -- ---------- <br /> Remo <br /> t <br /> •'Vy�4•r _..._ _.. ............... ._-..._ -----:- - ------------------- .-.---.-.-----..------ <br /> Remodeling and/or repairing (describe):...................... .. .... �• ---------'- � r <br /> z - ' <br /> r -------- --------------------------------------- <br /> .: <br /> t _ , -. <br /> ----------------- -------------------' -- -- -- - - ' <br /> Ihereby certifylthat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signe )+-'- -------- -- and/or Contractorl <br /> d .. -- -- ------------ - ----------------- --------- --------------- ' ' <br /> S ---- -•--- --. - - Title <br /> - -------------( + )------------- ------ ---- ---------- - -- - ------- --------- <br /> e (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> r FOR DEPARTMENT USE ONLY DA <br /> APP111CATION ACCEPTED BY _ l� _� <br /> --------- -------------------------- ---------- TE --....------------------------------ <br /> REVIEWED BY--------------------------- ----------------------- - - DATE' ' <br /> BUILDAlterlations and/or recommendations•---'---------- ------- -----'--- ---- -----'-'-- - -'------ ---- <br /> ING PERMIT ISSUED-------- -- ------- ---------------------------------------------------------------------------------- DATE--- ------- --------------------------------- --------------- <br /> / ------------------------------------ --------------------•----------------------------------------------- <br /> - --•----------- ------------------- <br /> --- ' <br /> - ------------------------------------- <br /> ----------- ----------------- --------------------------------' <br /> :i - ' - ' ----------------•---------- <br /> I FINAL INSPECTION BY ._ <br /> Date-*t a <br /> _*-------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California.: Lodi, California Manteca,California Tracy,California <br /> E.H. 2M 1-67 Vanguard Press <br /> , <br />