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FOR OFFICE,USE: <br />-------- ---------- -------------------------------- <br /> ii APPLICATION FOR SANITATION PERMIT Permit No. .... 197 <br />-----------------------------------:------------------­ '7--------------- <br />------------------------------ -------------------------- <br /> (Complete in Duplicate) <br /> 1. '�'BNEPQIte ,sued <br />---------- ------------------ This Permit Expires I Year From Date <br /> Application is hereby made to'fthe 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. 6�"l <br /> JOB ADDRESS AND LOCATIJO/4' ' <br /> ------------- <br /> Owner's'Name------- ---02 ---------------------------------------------------------I------ ----- --- ---- Phone---- ------- <br /> Address ----------------- - - ---­------- <br /> --------------- -------- <br /> ------------------------------------------------------------------- <br /> Contra for's Name------ ------ ---------------------------------- Phone-------------------- <br /> -------------- <br /> Installati on will serve: Residence Apartment ❑ <br /> House E] Commercial Trailer Co <br /> E] Motel E] Other <br /> Number of living units: Numiber of bedrooms Number of baths ___f__ Lot l size ...... ---------- -----�__LJ--------------- <br /> Water Supply: Public system ;Q Community system El Private [Depth to Wafer Table -------- ff. Vi <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam e/Clay Loam El Clay El Adobe E] HardpanE] <br /> j <br /> Previous Application Made: (if yes,clote-----------7--------) No E] New Construction: Yes No El FHA/VA: Yes F1 No F1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool per iffed-if public sewer is available wi+hin:200 feet.)P In! I <br /> Septic Tank: Distance from-nearest-we I ________-Distance from founda:fion--------------------- ------------------------------------------------- <br /> E] No. of cor�partmenfs--------- --- <br /> - ------Si�e........------------------------Liquid depth---------------- ---------(`apacify----------------------- <br /> Dispo4 Field: Distance from nearest well- �R-___._.Distance from foundation---- _.______.Distance to nearest lot line_!______-- <br /> of lines._________/__ <br /> --------------- Length of each line--------Y0 -'---_Width of trench----—---------------------____-- <br /> Type of-filter ------Depth of filter mate'rial------ ..........Total length------ -------------------- <br /> Seepag❑ e Pit: Distance to nearest well------------j--------Distance from foundation___________________ Distance to nearest lot line_______._________ <br /> Number of pits-!------- ------------Lining I-- - 9 material------------------------Size: Diameter------------------------Depth--------------------------------- <br /> Cesspool: Distance fi'-om nearest well------I--------Distance from foundation______________- <br /> ____..Lining material-------------------------------------- <br /> Size: Diameter_ Depth--------- -----------------------------------------__Li quid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------- -------- -----------------------Distance from nearest building----- --------------------- <br /> ,i --------------. <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------ ----------------------------------------- <br /> ,,Remodeling and/or repairing (describe): <br /> ----------t. �--------------- ---------------------------------- ------------------------------------------------------------------- <br /> ----------------------*----------------------------------------------- 1-- ---------------------------------------------------------------------------------------------------------------------------------------------- <br /> �!:::x�. <br /> --------------------------------------------------------------------------------------------------------------_-1.1--------------------------------------------a------------------------------------------------------ 0 <br /> --------------------------------------------------------------- ----------------------------------------- ------------------------------------------------------------------------------------------_------_----------5 <br /> I hereby certify that I have prepaied this application and that the work will be done in accordance with San Joaquin County <br /> —ordinances, Sttolaws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed}------- ------------------ -- -- --------- -----------------------------------------------------------------------------------------------------�"W_and/or Confract&irj�,^Q <br /> c., can <br /> By: ..... .. ............ ..... ..... ................... ..... <br /> _­ ----------- ------------jTitlej------------------------r----------------------------------------- <br /> (Plot plan, showing size of lot,.Iocation of sysfe in relation to wells, buildings, etc., Ce_�]�_cejon reverse S;Q—. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -------------- ---------------------------------------- D AT E_ S--------------------- <br /> REVIEWEDBY----------------------------4 --------------I---------------------------------------------------------- DATE-------:------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------—---------------I----------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I; <br /> ------------------------------------ --------------- ---------------------------------------------------------------------- -----------_1----------------------------------------------------------- <br /> - ------------------ ----------- ------ --------------------- ------------------------------------------------------------ ----------------------------------------------------- <br /> ij -I. <br /> ------------- -------------•---- - ------- ------- -------- ------­­-------------------------------------------------------------------------------------------------------------- ---------------------------- <br /> ----- <br /> ----------------------------------------------------------------------------------I--------------------------------------------------------------------------------- -------------------------------- ------------- <br /> -------------------- Date Lr-- -------- --------------------------------------- <br /> SAN <br /> INSPECTION BY:.. )Z._1 -- ----�1_ - --- ----- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Harellon Ave, 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street 4 <br /> Stockton,California I Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 0-59 2M 3-'63 F,F.cc. <br /> 9 <br />