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- <br /> ICE USE: �"�' <br /> Permit No. <br /> ------------------------------------ __ •7 <br /> FOP,OFF <br /> APPLICATION FOR SANITATION PERMIT <br /> {Complete in Duplicate) x Date Issued --��0`� / <br />"--"-----------"----------------- --- This Permit Expires 1 Year From Date issued <br /> ---- ----------- <br /> Application is hereby made to the San Joaquin ocal0 Health <br /> District <br /> for <br /> 9.a permit to construct and install the work herein described. <br /> This application is made in compliance with County <br /> [ z ---------------oe— ---- <br /> - --------------------------------------- <br /> JOB ADDRESST NDTLOCATION.11JJ,-1/-- _� '-zQ' � - "" <br /> { ----- . Phone--------------------•--------------- <br /> Owner`s Name--- -1 ---2AX-AIr" - -------------•-----------"------------------------ ------------------ --------------- <br /> -------------------------------- ---------------------------•----------------- <br /> Address---------••-- <br /> - --•----- ons.--•-------••--•-----• --- <br /> -- -------- ----------------- -•--------------------- <br /> Contractor's Name---�.�"A_�---------------•-------•------•- -- -- - - Motel Other ❑ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ <br /> Number of living units: -------- Number of bedrooms -"-"-private Number Depth.baths <br /> to WateroTable��2-- ff. <br /> Water Supply: Public system ❑ Commuriity system ❑ ® Hardpan <br /> Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay []FHAAdobe <br /> Y❑es ❑ No El <br /> Previous Application Made: (if yes,date.............._.-._f No ❑ New Construction: Ye E] No <br /> E] <br /> TYPE:OF INSTALLATION AND SPECIFICATIONS: <br /> ` 'No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material................------------------------ <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------. <br /> --------- <br /> No. of compartments Size Liquid dept h--------------------------Capacity.----- -------- <br /> pField: Distance from nearest well__..___.-.._----Distance from foundation_--._-•--,---------Distance tftfre Cher# lot line----------------- <br /> Disposal ---- -- -- .� <br /> ❑ Number of lines Length of each ----Total length-----------------=-------- ----- <br /> Type of filter material-------- ----------"-----Depth of filter material-._..... <br /> '_ , Distance from foundation_�t_--•------Distance to nearest lot line'4--- "- <br /> Seepage Pit: Distance to nearest well_ . .- ' ----- ,t <br /> F Number of pits---- Linin material.. ze: Diameter.y -`f--------- Depth_e�".f�--------- _ <br /> ------------- g : ? ` . <br /> i Distance from nearest well___..--.._..--_.Distance ram foundation- Lining material.._.._" <br /> Cesspool: t ---Liquid Capacity----------------------------gals. <br /> ❑ 5i7e: Diameter---------------------------- -------Depth----------------------------- - - - --- - <br /> Distance from nearest building----------------------------- ----- <br /> Privy: Distance from nearest well------------------------ •---------------.------- <br /> ❑ Distance to nearest loft line---------------------------------------------------------------------- <br /> Remodeling and/or "repairing (describe: --------------------------------- <br /> ------ <br /> ----------- <br /> I -------------------•--------------•--------•-------- ----------------------------------------------------------------------- . <br /> I hereby certify that I have re ared this,application and.that the work will be done in accordance with San Joaquin County <br /> P P <br /> ordinances, State laws, and ul�and-r;gulafions­of-Ae San Joaquin Local Health District. <br /> - ---------------- -------(Owner and/or Contractor( <br /> ---- <br /> ---------------------- <br /> (Signed)------ - - "�- -- Title <br /> - <br /> I erse side). <br /> (Plat plan, showing size of lot, location of system.in relation to wells, buildings, etc., can be placed on rev . <br /> FOR DEPARTMENT USE ONLY <br /> - -------- ----------------- ------ <br /> ----------- <br /> DATE---�.�3-�- --- --------------------------------- <br /> --------------------- <br /> APPLICATION ACCEPTED ----- <br /> --------- -------- - <br /> - --------------------------------- <br /> REVIEWED BY-------------- <br /> ----------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------- -------------- — - ---------------- -----------•-----------•-------------- --------------- <br /> Alterations and/or recommendations:----------............... . <br /> -------------- ------ <br /> R-;? <br /> ---------------------- <br /> - <br /> FINAL INSPECTION BY•,_ - --< '- --= ---------- <br /> -- -- ------- - Date- •---- ---- -- --- -- -------- ---- ------ <br /> SAN JOAQUIN LOCAL HEALTH, DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Lodi,California <br /> Manteca,California Tracy,California <br /> Stockton,California <br /> ES 9 REVISED B-69 3M 3-'63 F.P.CD. 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