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APPLICATION FOR SANITATION PERMIT Permit No. .....?J_9`-.... <br /> (Complete in Duplicate) <br /> Date Issued --- <br /> Applica4ion is hereby made to fhe:San Joaquin Local Health District for a permit to construct and install the work her_ein described. <br /> W_NTh* I' t' Js,macle�in compliance with County Ordinance No. 549, <br /> vp 4�,4 yp�ica ion /3 <br /> JOB ADDRESS AND LOCATION &Lj, e P�n atiec, <br /> s N f/. ---------- -------------------------------------------------------------- <br /> Owner' Name %!5ttr�---91 <br /> ----------------------4 -------------------------------------------------- - - -----------------------------------1. Phone-AL0­1---4UIT <br /> Address ------- 35 &_ � <br /> I ------- _4 (__1--------------------------------------- -------------------------------------------------------------------------------------- <br /> Contractor's Name-..----f =L_ j4 <br /> D ---- ---------------------------------- ------------------------------------------------------------ Phon __fj <br /> Install.ation will serve: Residence �artment House [3 Commercial [] Trailer Court E] Motel0,Other ❑ <br /> Number of living units: J----- Number of bedrooms _'V---- Number of baths ---I---- Lot size _66_41k <br /> Water Supply: Public system E] Community system 0 Private 0--Depth to Water Table 4�? ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe i2r'-Hardpan El <br /> Previous Application Made: Yes El No �'New Construction: Yes 9�No F-1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool perm,.iffed if public sewer is available within 200 feet. <br /> Septic 1pnk- Distance from nearest well--,-----" - ----Distance from foundation----"------------- Material-----_------.-____.---_-_..----..--.--_.-----.... <br /> No. <br /> aterial---------------------- <br /> --------------- <br /> No. of compartments----------- ---------------Size--------------------------------Liquid depth---------- ---------Capacity--- -D;sposal-OFi Id: Distance from nearest well-----------------Distance from foundation--- ------------ Distance to nearest lot line----__--------- <br /> Number of lines----------------------------------Length of each line------------------------------Width of trench <br /> ---------------- <br /> Type of filter material.------------__----. ---Depth of filter material---------- ....Total length--__----.._--------_----------_---- <br /> Seepag�_Pif: Distance to nearest ----------4-Distance from foundation--"- Distance to nearest lot line-- ------ <br /> ErNumber oft---------------Linin g material--1Diameter.___---- -------- --- Depth------- ----------- ------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_._._.--. ______.Lining material <br /> ------------------------------------- <br /> ❑ <br /> Size: Diameter--------------------------- ----------De th------------------------------------------------ ---Liquid Capacity----------------------------gals. <br /> C Privy: Distance from nearest well-------------------------------------------------Distance from nearesf building------------------------------------------ <br /> F1 Distance to nearest lot line <br /> Remodeling and/or repairing (describe]:-._c--------- - --­­----�i <br /> < -L4- <br /> ------------------- -------T� <br /> - T T _ A <br /> ------------------------------------------------------------------- - ----------------------------------------------------- ---I <br /> --- -- -----e-----L- ". --- ------------ ------------------------------ <br /> ------------ <br /> ---------- ---------- <br /> --------------------------I------------------------------------------------------------------------------------­-----------­---------------I------------------------I-------------­------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------•------.------------------------•-----.--.-••------••---------- <br /> ---------------------------------*----------------------------- A: <br /> I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin C.ou.nfy- <br /> ordinances State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed). ...... ... ----- ------------------------------------------------------------------------ ---------(Owner and/or Contractor) <br /> --- ------- <br /> --------------- <br /> -------- ------------------------------------- --------_----(Title --------- ------------ <br /> --------------------- <br /> 7 ;nTrel-ation--f o-w- e" buildings, efc.,`ca"ri 67� <br /> a placed d <br /> [Is, 6 :c�e�on reverse tde). <br /> location fs�ifeli� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------------------------------------------- DATE__�_D - <br /> REVIEWED BY -------- ----------------------------- <br /> ---------------------- -------------- --------------------------------------------------- ATE <br /> BUILDING PERMIT ISSUED--------------- ------------ -------- DATE --------- <br /> ------------- --------------------------- --------- <br /> Alterations and/or recommendations ----- <br /> ___P - - e . I, - ---- --- ---- --- <br /> -------------- -------------------------- --------- <br /> - --- - ----••---------•-- •--- <br /> ---- --------- ---- ----------- . ................... --------------------------------- - -------------- ------- <br /> -- <br /> - ------- <br /> - --- -- ----- - - ------------ ------ - ---- ------- <br /> FINAL --------- -------- <br /> INSPECTIONBY: ---------------- -----------I------ ----------------- ------- Date... <br /> ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9 145446 Arwood <br />