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ryr,v <br /> APPLICATION FOR SANITATION PERMIT Permit N .'.4',- <br /> , <br /> -' (Complete in Duplicate} <br /> ;;-... <br /> --- -------------------------- :._ �: ... .: <br /> -------�---------------- This Permit Ex fres 1E Year from Date Issued Date Issued- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to,construct and install the work hereir_i'.described. <br /> This application is made in compliance with County Ordinance No. 549 `/ I <br /> 1 <br /> JOB ADDRESS AN[1-LOCATION.- _ . <br /> Phone. <br /> I <br /> OwnersName ....:..................... ---•-------•-_-__-------•-•-•4 <br /> Address v...:............. <br /> -----------------------------------------------------------------------------------------................_.............-............... <br /> ... <br /> Contractor's Name - --------------------------------------------•--------------------------............ ......Phone................................. <br /> Installation will serve: Residence Apartment House ❑ .Commercial ❑ Trailer Court"❑ MotelO `❑ <br /> Number of living units: .-._._ Number of bedrooms ---3-. Number of baths __j.._ Lot size _... A:.._ ................................ � <br /> Water Supply: Public system T--c-ommunity system ❑ Private ❑ Depth to Water Table ft. n <br /> T Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U1,4ardpan ❑ <br /> �- Previous Application Made: (If yes,date-----------.--------) No New Construction: Yes [A"No ❑ FHA/VA: Yes ❑ No R�—r <br /> y ' TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic - -- <br /> k: Distance from nearest well. 7l�Disfance-from foundation_40..._.......-Material.....-. -Capacity <br /> _l ................ . ............. <br /> INo. of compartments--- -------- --Size..... °Z :.. . Liquid depth----- Ca aci <br /> Disposal F' d: Distance from nearest welLnC'�L[.-Distance from foundation__''^^ Distance to nearest lot line ............ <br /> aG � <br /> Number of lines----------- _ g �--. <br /> Length of each fine................ Width of trench------- .___.............._ <br /> Type of filter material._.! - plength ' + <br /> .. ...De th of filter maternal_._��..---...-._-Total .........---------­------------------ <br /> . <br /> __._---...................... <br /> Seepage Pit: Distance to neare ell.. --- --_._Distant fo dation_y�110--- .....Distance to nearest lot <br /> [rJ/ Number of pits---- ---.._.--Lining material_...�m --- ----Size: Diameter---- -.y -- <br /> Depth � *?• <br /> Cesspool: .Distance from nearest well-----------------Distance from foundation-----.--------------Lining material_.-..--.._. <br /> ❑ Size: Diameter------ •------------------- ----Depth--------------------- ---------•------ ------Liquid Capacity..----------------------•---gals. p� <br /> Privy: Distance from nearest.well------.1--------------------•-------------------Distance from nearest building---.-.---------------_---- __------------ `) <br /> ❑ Distance to nearest lo# line............................................. 1 <br /> -------------•--• <br /> Remodeling and/or repairing (describe):; --...--------•-----•-----••-•--------.----•--------------•----------•....................................... f). <br /> --------------------•--------------------------------------------------------------------------------------------------------------------.-------------------------------------------....----------------------••----•---- <br /> i = .....----•-------------•-•--....------------•-----•-----•---•-----------•-•-•--------•-----------------•--•--------------------...---------••----------•------•----•-- -------------•-----------•-------- <br /> --------------------------------------- <br /> ----------------•----------------- <br /> 1 hereby certify that I ha pr ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and r as d regulations of the San Joaquin Local Health District. <br /> (Signed)...).-- <br /> 51 ned ....:•----.......... -- - -------------------------------------------------{Owner.:bndJor Contractor)_ - <br /> By:.- y g....... :..(Ti#IeA ---•---------------------------------- <br /> (Plot ." <br /> plan, showing size of lot location of system in relation to wellst buildings, etc., can be laced on reverse side). <br /> FOlk MARTMEY USE ONLY <br /> APPLICATION ACCEPTED ------_ --- r <br /> --- - ---, •---- -- -------lam/------------------- DATE------ ---�'-�- <br /> REVIEWED BY------------------•---- --------------- -------------- ------------------- ------------- ....... DATE..-.--------------------------------------------- <br /> �' <br /> BUILDING PERMIT ISSUED -- r <br /> ----------------•-•--•-- DATE----_------- <br /> t <br /> ---_----- <br /> at , -; ---- . .. �, C_AFterations and/or recommen -- <br /> r -•----------------•--------•---•----------•------ - -----......----------------------------- --- ------ ---------- ---•-=----.....-------------•---•---•----------------------••-----•--•--------------- <br /> i <br /> .....••--••.....................-.....-.--.-------......-..__-....._.. - <br /> 4 <br /> FINAL INSPECTION1" -... "� pate , Yry'.�.' ._., �_ ..-.................. I <br /> SAN JOAQUIN LOCM,}IEALTH DISTRICT I <br /> r <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street <br /> r <br /> Stockton,California Lodi,California Menace,California Tracy,California <br /> ES 9 REVISED 8-59 2M S-61 ATLAS �Y <br />