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.yt. <br /> R OFFICE'USE: , <br /> r! ��� Permit No. <br /> ------- <br /> � _ APPLICATION FOR SANITATION PERMIT <br /> Com late in Duplicate) �,� Date Issued ------- / <br /> ----------- ----=----- --------- -------- . . . <br /> This Permit Expires I Year From Date Issued -, <br /> Application is hereby made to the San Joaquin Local HealWbistrict.for,a pe'rmi# to construct and install the work herein described. <br /> This application is made in compliance:with County Ordinanc"e No. 549_ w <br /> I ------------------------------ <br /> JOB ADDRESSe,AND LOCATION-2_1_3(o-------�# r`Z Q .* - ----------•------------ <br /> 1, . R ------- <br /> Owner's Name-----•� :_.�� - - -- -- ----- ---------- •-- <br /> ---------------- --------=------- -- ----------- --------- <br /> ---------- � - ------ s -------------- F '-`------------------------------------------- ------------------------------------------------------- <br /> Address3 - ' <br /> ' .. Phone-14 <br /> Contractor's Name--.----� -------� �'-------------`------------------•---,-^ ••------------•-• -- <br /> Installation will serve: ` Residence 1K Apartment House ❑ Commercial^'•❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> =- <br /> Number of living units: _ -- Number of bedrooms -- Number of baths _'-__ Lot size .- . r <br /> Water Supply: Public system ❑ .Community system [3F.riva elg Depth to Water.Table _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑1 .1 Sandy.Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C] <br /> I <br /> --_..J No New Construction: Yes No� FHA/VA: Yes ❑ No <br /> Previous Application Made: Ilf yes,date-------------- K y ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: .. - <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ' Distance <br /> n coin artmeres- ll------- -- ------Size----ce fr irilounclation-------------------Material <br /> Se tic Tank Dis#ante from"nearest well_..___----------Distance- -y � --__.Capacity._.___ . � Y <br /> ❑ p .......Liquid depth----------- - -- ---------- -- <br /> i . " <br /> _......:Distance to nearest lot line__-..._-...... W <br /> Dis-posal Fiel ._Distance from nearest well ------ Distance from foundation­,---.0!2X-1 6A <br /> t <br /> Len th ,of each line.........1.5. Width of trench-__________ ._- --- -----___-• <br /> Number of lines---------------- ----- - �9 � - - ----- - � <br /> z n ----Total length- --- ------- --•- <br /> --- ------- <br /> ------•---- <br /> Type of filter matenal.._I_ �.-_.___Dep#h of filter material.___.____ ..___ <br /> n n <br /> Seepage Pit: Distance to nearesfi welL.-r.-IQ��-_____ Distance om fo`yndation..._�_t �----Distant trio nearest lot line---.___. <br /> Number of pifs--'. _ j----------Liking' material_.- �----size: Diameter--------`t - ------Deptli---------- --------------- p� <br /> t. Cesspool: Distance from nearest well_________________Distance,from;;.foundation___,._,_.___..._,;,Lining;material---...-_______-_--_..._..,i_____-___-. <br /> -' ❑ Size,: Diameter' -- ------------ Depth------------- _ Liquid Capacity i gals. <br /> Privy: _.... _Distance from{nearest well........ <br /> --------------Distance from nearest building-�-------------- -------------- <br /> ❑ Distance to nearest lot line--------- --- -----------••------------------------------------------- - -------------- -------mkt <br /> 1 <br /> `i. i "----------•---- <br /> ------------- <br /> Remodeling and/or repairing (desCri6b):_-------_ a` ---- <br /> ------------------� -------------------------------- <br /> ---------- p <br /> -------------------------------------------------- <br /> 1 ' .. - -- <br /> -- . -,n accordance wit6.San Joaquin County <br /> I hereby Certify that ! haveprepared <br /> prP red this application and that the work well be done <br /> ordine s, State laws, and rule regulationsof the San Join Local Health District. - <br /> ! ----Owner and/or Contractor) <br /> (Signed)--- <br /> ------------------------------------------- ---- <br /> B 4 �, --�-- - ------------- ------------- --------- -(Title)-=---�----- -�-i-----------------. --: - - <br /> Y = ---------- <br /> ( (Plot plan, showing size of;lot; location syste in relation to wells, buildings, etc., can be placed on reverse side}.. <br /> I FOR DEPARTMENT USE ONLY <br /> 4 r -------- <br /> APPLICATION ACCEPTI=D BY....�.. DATE. <br /> DATE------------------------------------------------ -------- <br /> BUILDREVIEWED BY-- �..�.•w;.---------- --- -- -tet--------- - � -�_--- =��._r`.� ,. .m.. <br /> ING PERMIT ISSUED _- - ---._ DATE----------------- Wiz.. <br /> Alterations and or recommendations....._ .. ( �- <br /> I - LY � s. --- - ----- ------------ <br /> ------------------- ------------------------------------------------------------------- <br /> i <br /> -- ------------ ------ ------------- <br /> --------------- <br /> ----•-•----------------------------------------------------- <br /> FINAL INSPECTION BY:---- --a---wel-Jor=5------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH'DISTRICT <br /> 1801 E.Haxelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> wStockton,California M Lodi,California Manteca,California �� Tracy,California <br /> l - } <br /> E5 4 REVISED 8-59 3M 3•'63 F.P.0 O. iL <br /> y � <br /> t <br />