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VFO OFFICE USE: w <br /> O <br /> --------______----_------------__________•_.__.__.-_--- - APPEICATION FOR SANITATION PERMIT Permit No. �>�f~-............. <br /> � <br /> ---------------- ----- - --------------- (Complete-in Duplicate) r <br /> ------------------------ This Permit Expires I Year From Date Issued Date Issued <br /> E <br /> i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> I This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--_,. 0'? � ! --------- <br /> Owner's Name---•- _1------- la_4 ,e !--------------------- ------ -------------------- ------------ Phone-------------------------•--- <br /> Addressa.S .. -------- --------------------------------------------------------•• ---•------------------------------------------------------------------------------------- ........ <br /> Contractor's Name------ <br /> - �A <br /> �. .. ------------------ ----- Phone------------------------------------ <br /> Installation will serve: Residence ❑ i Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: Number of bedrooms Number of baths_/._ Lot size ��- !C-.fat_ - ___...__._ <br /> Water Supply: Public system ❑ Community system [Private ❑ Depth to Water Table .6�9 ft <br /> f <br /> Character of soil to a'depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g-17ardpan ❑ <br /> Previous Applicatio Made: (If yes,date_..-----._.._- -_ ) No New Construction: Yes �Vo ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION <br /> AND SPECIFICATIONS: <br /> - ;(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept c?Tank:- J Distance from nearest well:e�___Distance from foundation__e'�O__._... Material0'@AfA?,F- --- i <br /> ! ,3if Liquid depth ` -.--.-..Capacity <br /> compartments.__.a-------------- Size___ _ __ .___ <br /> V 1 <br /> Disposal Field: 'Distance from nearest welLl_0a_--Qistance from foundation_---/ --------Distance to nearest lot line_ -0 <br /> �^ h� Number of lines------ ___ -- Length of each line.-.4e-47 ................Width of trench__y�_ ________________________ <br /> Type of filter material,_ AA ,�_Depth of filter material__l� _.-..Total length_.._.*VI ______________________._.____ ' <br /> Seepage Pit: Distance to nearest well......--------._.----Distance from foundation--------------------Distance to nearest lot line_-._---______--- <br /> ❑ Number of pits -- ------------------Lining material--------------------- Size: Diameter------------------:----Depth-----.--------------_------------ <br /> I <br /> Cesspool; Distance from nearest well ________________Distance from foundation- ----- ..Lining material-_--....---_--.___.____.._.___------ <br /> Priv Distance from ne --------- -- -- --------------- Depth - Liquid Capacity gals. <br /> ❑ Size: Diameter. .. <br /> Privy: <br /> I <br /> well--_.............. .__-----......_-. .._.-----Distance from nearest building <br /> Distanceto nearest lot line -------- ---- -------------------------------------------- --------- ------------ --------------------------------------- -- <br /> Remodeling and/or repairing (describe :_____...- ' <br /> = - <br /> -- -------------------------------------------------------------------------- ------ <br /> }- � �1---�------ <br /> ---------- ----------------- <br />:' I hereby certify that I have prepared this application 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}-------------------------- � . p,/-_ - -- -._. ._._.._ <br /> f`� Contractor) <br /> By: ---------------- - - r�_..._(Title)._._ h ' . ..-........... ...._ .. <br /> (Plot plan, showing size of lot, location of syst in relafion to wells, buildings, etc., can be placed on reverse side). ' <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.- fT �, __-- y ---------------- - <br /> DATE_ _�g----------------- <br /> REVIEWEDBY------------------------------------------ - - ---- - --- -------------------- ------- - --- --- -------------------------- DATE---.-.----------- ------------------------------------------ <br /> BUILDING PERMIT ISSUED-------- -- -------------------- -------------------------------------..-------------------- - DATE. <br /> Alterations and/or reco 'end fons:.l___ __________ <br /> :. ----Ne!... -- --.r . ---- - --- 1------------------------------------------------------------ <br /> ----------------.P YA------- --. --- d ------- ------------------------- ----------- ------------- -- -------- -------------------- <br /> .......... f <br /> � { �� e <br /> FINAL INSPECTION BY:...._-.: r . ............ -------- -- Date------ ` i� 0 <br /> A J UIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />'~ odi. California a .r Manteca,California <br /> Stockton,CaliforniaCalifornia • Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> r ' <br />