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FOR OFFICE USE: <br /> --------------------- - --------------__------------- <br /> ------------------------ -------I-_---- ---------- - APPLICATION FOR SANITATION PERMIT Permit <br /> ----------------- ---------- --- ......_:_- --------- (Complete-in Duplicate) <br /> -- -----------... .......... .............. ...... This Permit Date Issued <br /> Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health'District for a permit to eonsfruet and install the work.herein described. <br /> This application is made-'in complian.6e with County Ordinance No. 549. <br /> JOB ADDRESS AN L'OCATIOUS Alf, <br /> ..7/ <br /> ---------- ------------ <br /> Owner's Name..--.---- <br /> -- -------- <br /> ----------------------------------- ------- --- -------- --------- Phone---------- <br /> -------------------------- <br /> Address----------------- <br /> , ------------------------- ---- -- ---------- <br /> Contractor's Name...__. . &;k. <br /> ---------------- - ------- -- ---------- --------------- ---------------.. Phone----- <br /> Installation will serve: Residence 2<Apartment House El Commercial E] Trailer Court El Motel El Other El <br /> Number of living units, Number of bedrooms Number of baths _101" Lot size ---dOL- -------- <br /> Water Supply: Public system ❑ Community system E] Private PT6epfh to Wafer Table ------ - ft <br /> I <br /> Character of soil to a depth o.f 3 feet- Sand El Gravel E] Sandy Loam [-] Loam Clay RT--'C'lay [:1 Adobe ❑ Hardpan 0 <br /> k Adb % <br /> Previous Application Made: (If yes,date_.-- ............. No El New Construction: Yes Ej No 0 FHA/V& Yes E] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> f <br /> Septic T nk: Distance from nearest'weII__..5ilP <br /> Distance from foundation.- --L...-_.-Material ----44--�_ <br /> ---------------- <br /> No. of compartments------- -- 'r <br /> __Sj1 . -,r�,r` <br /> Liqu�d clep�fh_------4_ ... ...... <br /> Dispose I d: Distance from nearest Distance from foundation----:_14.. ....Distance to nearest lot line--V- <br /> Number of lines --------- ---------Length of each line-. -----6D."_------------Width-- of trench. ...,2 <br /> Type of filter Depth of filter maierial-----Z.Af _Total length--- ------------------------- <br /> See/Pae it: Distance fo nearest W'11 ......Distance,from foundation---- ----.._.-.Distance to nearest ]of line <br /> Number of pits... ..-l_.....__.1 -Lining materiai_ Size: i -_ -_ <br /> D amefer------ellp---- -----Depth.. .Xi-------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----- ----------- --Lining material------------------------------------- <br /> 0 Size: Diameter- ------------- ------------ ---Depth-- _-------------------------- ---------------- _Liquid Capacity------- ---------------gals. <br /> Privy: <br /> Distance from nearest well--------------------- ----------- --- ---- <br /> -----Distance from nearest building❑ ------------------------------ --------- <br /> Distance to nearest lot line- ----- ...... <br /> Remodeling and/or repairing -- <br /> (describe): <br /> -------------------------------------------------- ------- -------I-_ .. -- -- <br /> I ..... 4 ----- -- ---- - <br /> A--- -------- ----------------------- --------------------------------- <br /> -------------------------,--------------------------------------------------- ------- --------------------- --------- <br /> ----------------------- --------- ------------------- --------------- <br /> ------------------------------------------ ----------------------- <br /> i-------------------------------------------------------------------------------------------------------------------------------------------------------- <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'lav;s,pn rules and kegulations of +he San Joaquin Local Health-District. <br /> (Signed)--------------------- <br /> -- <br /> -- --------------- ------------ ---- -------- ---------- <br /> rr <br /> :------------------- -- --- --------(0;XFr-and/or Contractor) <br /> By • <br /> -- <br /> ---------i--- --- ----- -------- ------------- ---------------------------------------(Tif le)---------- ------------ . ....... .... ..... .. ... ..... ... <br /> (Plot plan, showing size of lot, location I of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.............--- <br /> RE-VIEWED BY --------------------------- -------------- DATE----�2-------/A---774 --------------------- <br /> BUILDING PERMIT ISSUED-------- ------ - --------------:---------------- - -------------------------- DATE---------------__--------------- ----------------------- <br /> ----- --------------------------------------------------------------- ­-------------- DATE..-.-------- <br /> Alterations and/or recommendations:....{...-..-- <br /> �I ------- - ----------------------------- -------•- ------------------------------------------------ ----- <br /> ----------- --- -----------------:-- --------------- -------------- --- --- ----------------- ----------- --------------------------------------- -------------- ---------------------•--------•------------- <br /> -------------------- --------------- - -------II <br /> ----- ---------- <br /> - ------------------------------------------------- <br /> ------------------------- ------------------------------------- ---------------------------- <br /> ------------------------ ----------- -----------------------------;I ---------- <br /> - <br /> .......I... ------------------------------- --------------------------- ----------------------------------------- -------- ------------------ - --------------------I--------- ---- -------------I—---------------------------------- ------- ---------------------------- ------------------------------- .......... <br /> FINAL INSPECTION BY-------------- Date__2_7710�r__O� C"., <br /> ------ ---- ------------ ------------- ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 1300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California <br /> Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />