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ren-—'J.`"�'r• � -^ � � <br /> FOR OFFICE USE: ; <br /> • <br /> ''---- d rte: J APPLICATION FOR SANITATION PERMIT Permlt No. ---•-----------=--•----- <br /> _ - (Complete-in Duplicate) Date Issued =- � --y <br /> �..---• This Piaimit Expires 1.,Yiar From Date Issued <br /> Application is hereby made to the San Joaquin Local Health Distric# for a'permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance N6.. 549. <br /> -------------------- <br /> 4 --- s-J•-�---f-�--'-'-- - --•-s- <br /> ----- <br /> --,- <br /> ---------•----------•-----•-------/ <br /> JOB ADDRESS AND LOCATI N _--_-__� - -- --- - ----- <br /> Phone <br /> -' ----------------- <br /> Owner's Name-------'-(' . -------------------- --------- <br /> Address.- <br /> ------- <br /> - <br /> Address. Pho <br /> -------------------- <br /> _r/7._..... <br /> " <br /> r <br /> Contractors Name----------- t•- r- <br /> Motel her ` <br /> Installation will serve: Residence � Apartmant House,❑- Commercial E] Trailer Court E] � ❑. Other <br /> 'a 1; f <br /> YNumber of baths-_ _._ Lot size ____ <br /> Number of living units: _. .__-- Number of bedroons,_" _.-- <br /> Water Supply: Public system ❑ Community systerri �Priva�❑�De'pth fo Wafer Table="' f <br /> Character of soil to a depth of 3 feet Sand ❑ G avel ❑ Sandy Loam ❑ Clay Loam Clay Adobe Hardpan ❑ <br /> --J. r i FHA%VA: Yes ❑ No ❑ <br /> Previous Application Made::,(If yes,date..c.-.:._------`✓ -I) No New Construction: Yes ❑'No ❑; S <br /> t„ <br /> TYPE OF INSTALLATION,•AND"SPECIFICATIO-NSA--3 <br /> No septic tank or cesspool�persilittad if <br /> -publiq;sewer is avaiiable�,within 200 feet.) <br /> Septic Tank: Distance from nearest yell- .."77__ Distance ,f"ro"m foundatson-.-�--__-:p...__Material ---------------------.___._____--.-.---------- <br /> Li uid de th--------- ------- --------Capacity----------------------- <br /> ❑ No. of tom artments_':-- - -----� ...Size-------------------- ----------- q p• <br /> r . e fu <br /> Disposal Field: Distance;from.nearest -- r !i , �� <br /> P. , <br /> well_._..-..-�---4-:Distance from foundation._.- �---.------Distance to nearest lot line_- _- <br /> p .� -�f . <br /> Number of lines.-- --==--=. :� - Length of each line-- --- :-----'------- Width of trench.._/2 r---.--------' <br /> `7 — �3 <br /> Type of filter material._._K�-e' -----Depth of filter maternal.-..,- __.�..__...._Tota1 length____._ -. <br /> ri -..-� ..sa,- �_ Fes-- <br /> I Seepage Pit: Distance to nearest well---------- Distance fr m f' undation____� .______.Distance to nearest lot line__d` _..__... <br /> ��' Depth.- <br /> Linin material._ Size:;Diameter._._ � ----------- <br /> Cesspool:- Distance from nearest Fell _. --_-Distance from foundat'ion----------------- --Lining materials____......___.____._______________. <br /> Number o pits----_ <br /> ` � <br /> . _ � -" ------ <br /> D <br /> -.- --Liquid Capacity - -- <br /> gas <br /> S+ eDiameter- -- -'- -- --'- '------ th---- ------- -- - <br /> � 4, , <br /> Distance from nearest wet- ---.--- = --= ,::Distance.from nearest building----- ------ ------'------- <br /> F Privy: --------------------- <br /> ------------- <br /> a ti. --- <br /> ❑ Distance to nearest-lot-fine <br /> �. -------------------------- ---=--- <br /> - <br /> Remodeling anti/or repairing (describe):------•.......:.:..... ::;':I - ; - ,Z ', <br /> i ----------------------- -- ---------------------'---------. <br /> - 'l <br /> ------ -------- -- - <br /> . . <br /> ! hereby certify that I have prepared_this a Ilca.tion_and�t iatfthewcA will.6e_done in accordance with San Joaquin County <br /> ( ordinances, State I , and rules a regulations of the San Joaquin Locnal Health District. ,. <br /> ` --.?�e_- ( ner and/or Contractor) <br /> j, }- <br /> I <br /> (Signed)--------- ---- ---Title -- --- <br /> -- ---------. ' <br /> r BY:----------- <br /> --- . <br /> (Plot plan, showing size of las, location of s em in relation to wells, buildings, etc., can 6e placed on reverse si e. <br /> F ) FOR DEPARTMENT USE ONLY <br /> rDATE....' ' - --- ---- � ------------------------- <br /> APPLICATION ACCEPTED $Y__--_--- - ---- ----------------- <br /> ( <br /> DATE-..-.-- <br /> REVIEWEDBY------------------------- ------------------ _---------" ---------------.----- -------- -------------- <br /> BUILDINGPERMIT ISSUED---------- --------------------------------------------------------------------------- DATE - ' - <br /> Alterations and/or recommendations----------------------- ------- --------- 4-_e------------------ <br /> d-------•--------------'-------------.-_-----_-------------•-- <br /> --- ----------------- --------- <br /> ------ ---------------------------------------------.-.-.-.-.-.-.-.-.-.----------------------------------------------I------------ -.-.-.-.-.-.- <br /> -----' <br /> ---------q-------------------- <br /> 1 -------------------- -------'--'- ------- ------------------- ------- ------------ --- --------- Q' <br /> ........ <br /> FINAL INSPECTION BY:._-f ----- ------ Date------------ <br /> . f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:olton Ave. <br /> 300 West Oak Street 124 sycarnore Street 205 West 91h street <br /> Stockton,California <br /> Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />