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'APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> This Permit Expires 1 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 herein described. <br /> This application is made in compliance wit rd;inance No. 5549. 5 It- <br /> ---- --- ------- - -- ----- - ---- <br /> JOB ADDRESS AND LOCATION--------------------------------------- -------- -57 <br /> Owner's Name----- ----------- ------ -----------------------------­-, Phone------------------------------------ <br /> Address---------------------- ------------ - --------------------------------------------------------------------- <br /> ---------------- <br /> ;,7 <br /> '7�j a- - - _--n <br /> ---------------- Phone---- -- -------- <br /> Contractor's Name--------------- ------------------1_e7-------------------------------------------------------------- <br /> Installation will serve: Residencej2K Apartment House E] Commercial E] Trailer Court [:] Motel E] Other E] <br /> Numb6r of living units: ---/_ 461mber of bedrooms __2,_._ Number of baths Lof,,size-------------------- -----;Z_�e--------------------- <br /> Water Supply: Public. system ❑ ComOunity,,systerd"E] Privafe -Depth-t6-Wit6r, aQe------77T.—� <br /> Character of soil to a depth of 3 feet' Sand L] Gravel E] Sandy Loam E] Claygo"arn 0 Clay E] Aclobe'N' Hardpan El <br /> Previous Applicafion Made: Yes New Construction: Yes <br /> No 0, FHA/VA. Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> f i <br /> (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) <br /> 4re <br /> rn foundation-----/_O?�------Material___.__— ------------Distance from ------------- <br /> Septic Tank: Distance from nearest w 'If <br /> -4 No. of compar1tme1nts______ --::t-------------- ---Liquid depth---- - ---- ----Capacity.___------------------ <br /> -Fie14: Distance from nearest 'stance foundation______-- ----------- <br /> _6` - <br /> Disposal. arest well---------------- I f�rc�m founda ______.._y-Distance to nearest lot <br /> i Numb6r of lines________._--?................ Lenth of each line---------------Ir�_ �__'.Wiclth of trench------------- ----------------- <br /> Type of filter 0)material-'-----_. :-- <br /> ---------- .-.-'-.-,Depth of filter material-----------------------Total length----- --- -- <br /> NZ-------------------------- <br /> Seepage Pit: i Distance to nearest well`d--- ----Di,sfance fro foundation--- DiWince to neqesf lot line---ZJY_' — <br /> R Number of pits-------Z.`----------Lining material-___ Dia mete --------------------- <br /> Qr <br /> Cesspool: %t` Distance from nearest well-'__--_'_-____ibIstance from foundation--------------------Lining material-I--------------------____.__-______ <br /> ❑ Sizer Diameter--------------------------------"T_-:�i.Depth------------------------------------- --------------Liquid Capacity----------------------------gals. <br /> Privy- Distance from nearest well--------------`----------------------------------Distance from nearest buiiding----- --------------------------------- - <br /> Distance to nearest lot line--------- ---`i <br /> -- ----------------------------------- ------------------------------------------------------------------------------------------ <br /> Remodeiin and or re'pairi des ri ' --------- --------- ------- ------------------------------------ <br /> ZV (,_�3 - --------------- <br /> A ...... -- --------------------- --- ---- ------- -------------- ------------------- <br /> ---------------- ---- -- ---------------- <br /> :j <br /> --- <br /> -1,- ------- ------ <br /> ------------ <br /> ---------------- ------------------------------ -------------------k ----------------------------- ------- <br /> -- ---IIJ--------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this applicaltion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State 'laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)- ------------------------------------------------------------------- Contractor) <br /> -- --------- 7- <br /> ----- --------------------------- --- ----------- <br /> By—_1 ----- location of s stem in ells, buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size cifo.-��, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- i <br /> ------------ !----n------------°-----y------------ I ---- ----------------------------------------------------- <br /> - <br /> t- - <br /> REVIEWED ' Y---------------------------------- ----- ------------- . DATE <br /> BUILDINGPERMIT ISSUED---------------- '--- -------rn------- ------------------------------ DATE------- ----------------------------------------------------- <br /> Alterationsand/or recomrnendations:------------------------------------------------------------------------------------------------------------ ------- ------------------------------------ <br /> ----------------&H------ ----- ------ ------------------4---------------- <br /> We - - - - ---- ---CLM <br /> -------------- --------- - ----- ------------ - ------- -to <br /> -_ <br /> I� - - A, <br /> -------------- ------ ----- ---------------- --- --- -------- --- --------- <br /> ------Am---------- ---- ------- <br /> - ------------ ------ --------- ---------------- --------­ <br /> ------------ ::k <br /> FINAL INSPECTION -------------------------------------- ------------------------- Date-------:- ------------------------ ------ ----------------------------- <br /> ---t-----4 <br /> B <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 1 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Rev;sed V59 F.P.Co. <br />