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' FOR OFFICE USE: i. <br /> - / �e----------------------- <br /> 19l <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />- ---------------------- -- - ----------------------- - I {Complete iri Duplicate) <br /> Date Issued <br />--------------___' -----.__.._.____.,.__._...__.__----_ I 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 Ordin nce No. 549. <br /> JOB ADDRESS AND LOCATION.__._" ( il�(�1n1- - --- ----------------------------------------------------- <br /> PP <br /> } nA <br /> _l -------1�'L R-r -------------------------- -- Phone-- <br /> Owner's Name------------------------------------•---=..-... - --- V <br /> Address U--------------------------------• I p <br /> Contractor's Name------=----------------•--------------� -A-0-------------_x--- - ---- Phone.q_�?--GG... <br /> Installation will serve: Residence x <br /> Apartment House ❑ Commercial E] Trailer Court ❑ Motel ElOther ❑ ` <br /> Number of living units: ___ ___ Number of bedrooms Z—N <br /> . umber of baths I____ Lot size __�- �'�________--_-:_.-__.___ <br /> Water Supply: Public system %, Community system ❑ Private ❑ Depth to Water Table. ft. <br /> Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ <br /> i <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No;A, FHA/VA: Yes ❑ NON <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic.Tank: Distance from nearest well--,5-0____._ Distance from foundation___LQ1________:Materiaf__.N_ <br /> - -- <br /> ( <br /> Nof:compartments------- r'. ---Size---�R_ -� j- -----Liquid depth----- -«-------Capacity----- ---------- , <br /> ._" <br /> "Disposal .Field:- Distance from nearest well....�01_-Distance from foundation----1_t2_1-------Distance to nearest lot line__.'7---------- <br /> m' �= Number of lines_.:______-_ Length of each line_ Q tQ Q q�_.Width of trench - <br /> >`. 9 . <br /> of Zo <br /> Type of filter material... t'._ epth of filter material.-. L-�0-------Total length------t_-IS- _____________________ t <br /> 'Seepage Pit: Distance to nearest well___'_---------------Distance from foundation--------------------Distance to nearest lot line_____________.__ <br /> ❑ Number of pits......'---=------------Lining material---------------___--...Size: Diameter-----------------------Deptn--------------------------------- <br /> Cesspool: -Distance from nearest well-----------------Distance from foundation------------------..Lining material------------------------------------- <br /> ❑..,..' Size;.Diameter l------------- -----------------Depth-------------- -------------------------------------Liquid Capacity----------------------------gals <br /> . <br /> Privy: Distance from nearest well ____,._______________________-----_-------------Distance from nearest building.____..__.__________________..__..___-._. <br /> Distance to nearest-lot line__________________________ ^ <br /> Remodeling and/or repairing (describe)------------- _ ------ -----------�- T~" - ---------•----------------------------- <br /> I <br /> I hereby certify that ( have-�re `tired this application and that the work w________________"__--------"-"-------"-------"----"--"" --:--­---------- <br /> - -- ---- ----------- -------------------------------------- <br /> y y -p p pp ill be done in accordance with San Joaquin County m <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> t <br /> (Signed)------------------------- �' -;--------1- N-- --------(Signed) er and/or Contractor] <br /> By:--------------------- --- ---- --------- - ;. ------------------------- ------(Title)------ <br /> (Plot plan, showing size of lot, location of system in relation to vre,IJS,.buildin(js, etc., can be placed on reverse side). <br /> FOR DEPAlRtMENT USE ONLY <br /> APPLICATION ACCEPTED ------ - ---- -------------------------------------------------------------- DATE- t2_'--- --------------------- I <br /> REVIEWED BY--------------------------------------------- ---- --------------- --------t-------- ------------------------------------- DATE---------------------------- -- <br /> -------------- <br /> ------------- <br /> BUILDING PERMIT ISSUED----------------- ------------------------------ ------=- - DATE - --- <br /> - = <br /> ., -- -- - ---------------- <br /> Alterations and/or recommendations:------------- -------------- -------;----------------------------------"-------= ------ i <br /> ---------------- - -- ------- ----------------------------------------- ------------------ ------------------------------------------- ----- ---- -- -•--------------- ------------------------------ <br /> " ------------------ -------- ------ --- --- ------------------- ----------------- -------------------- --------------------------A -- ----------------------------------------------- - <br /> k <br /> ______________________________ 7w- <br /> ----------------------- --..._-____ <br /> ' Date_ � ' --------�c <br /> r ' <br /> FINAL INSPECTION BY: - �-. �-r---------- --------- ----- - ------------� �� - - - - -- <br /> r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California I Lodi,California Manteca,California Tracy,California <br /> F-.P-Cfl. <br /> F <br />