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FPR OFFICE USE: <br /> - . -- ------------------- -�.---_--� APPLICATION FOR SANITATION PERMIT .. Permit No. __ ! 0._.....:3 <br /> -------'----------------------------- --- (Complete in Duplicate) <br /> _ __l_ <br /> _ -- <br /> This Permit Expires 1 Year From Date Issued Date Issued ----- ______�y <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 o. 49. <br /> JOB ADDRESS A LOCA�In,'--lN ±Z-2__-- _ __._-: I <br /> - -•-•--. - ----- ---------------------------- ----------------------------------------------- <br /> Owner's Name_-- J-- ---- -- --- -•---- •-- - ------- Phone----------------------------------- <br /> Address--------- <br /> ------------------------•Address-----._._ _._. ..__ ---------------------------------------------- <br /> Contractor's Name------------ = ` 1 Phone. <br /> Instaliation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___ __ Number of bedrooms _- umber of baths I_____ Lot size __t�5....ij_7..-,-e__.-�_O.P------------------------ <br /> Water <br /> ?______________________Water Supply: Public system ®--c—ommunity system ❑ Private ❑ Depth to Water Table X-oft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Eq---5ardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No Eje"N`ew Construction: Yes R-<o ❑ 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 Ta Distance from nearest well--__Distance from foundation_1D__,_________Material_____) ------..yff�'O:_�.._____. <br /> r <br /> No. of compartments_.-__�---------___Size-----3x__ '�_.4'-----Liquid depth--__'F___-----_--_-__--Capacity___ ---- _ <br /> t <br /> Disposal Fie : Distance from nearest well---- °'_'�`Distance from foundation_Af--------------Distance to nearest lot line_________�_--- <br /> Number of lines-:--t--. ---------Length of each line----_r_4-_`--------------Width of french-._;r _�---------------- � <br /> r .Total length tj <br /> of filter materia---L_c�C_t'___-__Dpth of filter material . `___.______ g J <br /> 1 t �� r <br /> See pa Pit: Distance to nearest well-_ " ----------Distance from foundation _[?______.__ Distance to nearest lot line---_____________ ./ <br /> Number of pits.-.---I---------------Lining mate ria l-."_%EL1_C/CSize: Diametea��_ .--------Depth ^.,----------------.---- <br /> Cesspool: Distance from nearest well-----------------Dista`nce from foundation------------------- Lining material __.____-_______..______.________.___. rn <br /> ❑ Size: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. + <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building--r__.-.__-__--_----------_----------..__ <br /> [] Distance to nearest lot line-----------"------------------------------------------- <br /> -------------------------------------------------•------------------------------------ <br /> Remodeling and/or repa�r;ng (describe):--------------------- -------- ----------------•---•-------------------------------•-------------------------------- --------------------- <br /> -•- -- ------------- ---=- -------- - ----•------------------------------------ -------------------------------------- <br /> --------- <br /> I hereby certify that 1 ave p pared Its app lication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, an rules nd reg ations of the San Joaquin Local Health District. <br /> r <br /> 'i <br /> (Signed)---------------------------- ----- nod <br /> ------------------------ -----------i ------- ---------------------------------------------------------(Owner and/or Contractor) <br /> BY: ----------- ------ - -- --- --- -- -------------- `}},----------------------- -- - -----(Title)--------------------------------------- -- - -------------- <br /> (Plot plan, ow o Of. location o system in relation to v,,ells, buildings, etc., can be placed on reverse side). <br /> F911 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- '" � ---------------------------------------- DATE------ =1` � �c�------------ <br /> ''- <br /> REVIEWEDBY-----------•-------------------------------- ------------ ---------------------------------------------------------- DATE-----------•----------------------------•--------- •------- <br /> BUILDING PERMIT ISSUED------------ ----•--- - DATE-----------------------------------------------------•------- <br /> AI#erations and/or recommends ions:._. __^ .' -- <br /> L �� =Imo. ,___ _-. �.. __ ,C <br /> -r_3 = _ <br /> w <br /> ---- ----- -- <br /> ' ----- <br /> CJ <br /> -------------------------------------_----_-------------------------- <br /> ,--------_-------.--------------------------------------------------------------..____.-----------.--.----------------------C__._'--------.-_._____ <br /> FINAL INSPECTION BY:- ---�----_ ------------------------- Date. -' n <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> VS 9 REVISED 5-59 3M 3-'63 F,p.CD. 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