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FOROFFICE USE: <br /> _______________..__._.-_.__.__.._.- -_._.______ APPLICATION FOR SANITATION PERMIT Permit No. _.. ..t......_ . <br /> -----------­--------------------------------- --------- (Complete-in Duplicate) Date Issued 5_7-'-_:?.7.-=t°.L� <br /> --------------.--- ----- --------------- _ --- <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 construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN LOC TION..... -- ----------- -- --- = I....-- <br /> Owner's Name... Phon s��7� ... <br /> - <br /> Address. -��---------- -------- ------- ----------------- <br /> ------------ y <br /> Contractor's Name--_ - - ------ ---- - - ---------- -------------------------------.------.------- hone. -..d�' �. <br /> Installation will serve: Residence 10 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other C] <br /> .-X�,3--- <br /> Number of living units: _- �.. Number of bedrooms -�-.- Number"of baths ... <br /> __ .- Lot size _-.. _Lj <br /> Water Supply: Public system Community system ,® Private ❑ Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------- -------- _ ) No X New Construction: Yes a 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 /> l <br /> Septic Tank: Distance from nearest welL.j1,07Z4--Distance from fo ndation_. -i <br /> ---.---.Mate ial p! _ _---- 2- <br /> is .2-- <br /> No. of compartments-------- -----------Size.. .. <br /> - ._*,�9 <br /> --- --------------Liquid depth-6-7, -------.Capaclty.A240 .. <br /> Disposal Field: Distance from nearest well__X0,T ...Distance from foundation--AL- ----------Distance to nearest glot line-Jam_.------._. <br /> Number of lines----------- --.-_.._.Length of each line__.Gl.�.._... Width of trench_...070.e........__------._... <br /> Type of filter mate ria l.`�rr�� X#CeDepth of filter mate ria L/�.�l--.----.--Total length... �......................... <br /> Seepage Pit: Distance to nearest well-------.--------------Distance from foundation....................Distance to nearest lot line--..------.-.---- T <br /> ❑ Number of pits------------------..Lining material--------------..------ Size: Diameter-----------------------Depth----------.------..-----------_.- - \ <br /> Cesspool: Distance from nearest well ................Distance from foundation----------------- -.Lining material_.._._..._-----------__....._--_-_--_ <br /> ❑ Size: Diameter- -- -------------- ----------------Depth-_---------------------- -----------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well-----------------­------ - - ----- -Distance from nearesfi building__..__-_.._...-..-.-.--_.__-- r� <br /> p Distance to nearest lot line----------------------------------------- �V <br /> Q <br /> Remodeling and/or repairing (describe) - ------------------••• -----------------•-_----------------------------------------•_---..-------------------------- <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) fly- - -- -- -1��' - ------- ------ ------- - -------(Owner and/or Contractor) <br /> By:------- ------ ---- ------st ------------ -----(Title)---------------- ------- <br /> (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B - -- - -------------- DATE.-----G �-- ------ <br /> REVIEWEDBY--------------------- ----- ----------- - -------------- ----------------------------------------------------1 DATE--------- <br /> BUILDING PERMIT ISSUEC6 ----------- --------- ------------------------------------------------------ DATE.-------- ------------------------- <br /> Alterations and/or recommendations:------ ---------- -------- -----•-_-------------- -----------..------------------------------------------------------------ ---------- <br /> ---------------------- ------------------ -------- ----------------------------------•------------- ---------------------11------------------------------------------------------------------- <br /> J� . Date - -FINAL INSPECTION - -p�o�' �- <br /> OAQUIN 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 /> EX 9 2M 1.67 Vanguard Press <br />