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FOR OFFICE USE: <br />. <br />--------------------.................................. <br />APPLICATION FOR SANITATION PERMIT Permit No . ........................ <br />......... ---•....... ,•--•-----.---.............. (Complete in Duplicate) Date Issued'f <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. 003-0$0-1� <br />JOB ADDRESS AN LOCATION_ _ _ ._ <br />.-- ----� L QCT. <br />Owners Name_.... Pone_--_---------O-----f---­.. <br />Address. ...�k° __ .......... ........ <br />p / <br />Contractor's Name.--------- r, J- _ hone.._.__._. v <br />Installation will serve: Residence E] Apartment House El Commercial ❑ Trailer Court Motel Ll Other <br />Number of living units: ... ./ Number of bedrooms -,*""N umber f baths .1____ Lot size�..���--------- ----- - <br />Water Supply: Public system F71Community system ❑ Private [Depth to Wafter Table _._.____ ft. <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ZHHardp6an ❑ <br />Previous Application Made: ({f yes, date ....................) No 171New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.)r - <br />Septic ank: Distance from nearest well___,,rJ.�l.Distan e fro oundation ....... 1j9_�_.Material __-- ................ <br />f f ,� (iquid depth-- ---`3� �...__.. --- Capacity -----I <br />No. of compartments..._ ------------- ... __�--X �-'^�-•��-- <br />i <br />Dispos Field: Distance from nearest well:.�5Q._.... Distance from foundation--- 1.b ----- _.._.Distance to nearest lot line_c5....._.__ <br />Number of lines :._________.__. Length of each line ----- ..... Width of trench_._..`..,�Y.._._...____.__ <br />Type of filter mafieria{....f�P�...__Depth of filter materia$____._/ --k-.____.__. Total length_._.__...f_ 0_Q ...........:........ " . <br />See pe e Pit: Distance to nearest well ---- .lay.._..__Distance from foundation...._.' ?_r..Distance to nearest lot line _... ............. <br />t p 6/1 Flim <br />Number of pits ........ ------------ Lining material_.-__ , __Size: Diameter ..... 44._ -p <br />tr � <br />Cesspool: Distance from nearest well_________________ Distance from foundation ..................... Lining material .-____.._._._..__..___._._.__.....___- C� <br />[� Size: Diameter------------------------_--- -- .... Depth ----------------- ----------------------------------- Liquid Capacity ............................ gals. P <br />Privy: Distance from nearest well -------------------------------- ____------------- Distance from nearest building ----------------------------------------- <br />❑ Distance to nearest lot line------------•-------•-----------------------•----------------.-._._........... •......... .... _..------------............. ------ <br />Remodelingand/or repairing (describe)--- -------------__---------•-•............... .----------------------------------------------------------------- -------------_____.._.......... <br />-------------------------------------- .--------------------------------------------------- .------ _...--•-•-------.__..----•--••-•---------------------.___.............. ----•-- •----------- <br />•--------------------------------------------------•------------•-•-•-----------•----•-----_-------•-------------------•---------------------•-----•---------------------•---------•----------- .......................... <br />..... .................................... ------ ----------•-----------•---------------------•-------------------------------•--------- -•---------...... .--------- ;-•-----------•----•................. ------------ ---- <br />I hereby certify at I ve prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State I fs an r les and regulations of an Joaquin Local Health District. <br />----- ------------- -- - -L�. <br />------ and/or Contractor <br />(Signed}------- • ---------_----------_-----------� ) <br />B; .._...._.. ----- --- ------ (Title) __......._.. - ......... <br />Y �; -- - <br />(Plot plan, showing of lot, Location o system in rela 's, b Ings, etc., can be placed on reverse side). <br />,} -FOR <br />�DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY /fr�:�` r!1--------------------------- ----• DATE l 0 /S' G ;f <br />---- <br />REVIEWEDBY ------ ----- .................... ------------------------------------------------------------------------------------------- DATE-- '-----........:----------- ......_.----------=-------- <br />BUILDINGPERMIT ISSUED.. ............. --------------------------------- --------------•----_..------------------------------ DATE <br />Alterationsand/or recommendations:. ......................... ---------- ._.---------------------------------------------------------------- °--------------------------------------------------- <br />------------------- -- ------....... •-•------_..I._..._...I......-------.--------------• -----------------­- ••--------•----.........._-------....... -------......... ----•---_................. --... <br />-------------------.................. ----•------- -------.._...----- .....-----....... ............................. ------.:..................... - -----. ---_.-......--•-------- ........ -•--- . <br />FINAL INSPECTION BYf, ' '" ?-tc•Date.. -- .... - ................. .........-.......................... <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1501 E. Hazelton Ava. 300 West Oak Street 124 Sycamore Streel 205 West 9th Street <br />Stackton, California Lodi, California Manteca, California Tracy, California <br />1 �5' 9 p2VI5EO 8-69 3M 3-'63 F.P.00. <br />