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FOR OFFICE USE: . <br /> -------------- ------------------------------------------- <br /> ------------------ ---------------------------------- APPLICATION <br /> --- ------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _.. -2.9 <br /> --------- -------------------------------------- (Complete in Duplicate) <br /> Date Issued <br /> ---------- I This Permit Expires 1 Year From.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 /> Ti, application is,made in compliance with County Ordinance No. 549. 17 Z/ ' _� <br /> JOB ADDRESS AND LOCATION___________------ <br /> ____4 <br /> _ _ -- ---�--------- <br /> ion .m - <br /> . 2_1 c CP w AJ a,2./�;cpv ry f <br /> • <br /> Owner's Name ----_--- 1-----'---'----- -------------------------------------------- Phone_---------------------- a <br /> Address �� —�----f-----------------------------------•--=----------------------------------------------------------------------...__......................... <br /> Contractor's Name----------------- =�Y/• t-------"--------------------- -----•--------------------------------------------------------- Phone.................................. <br /> Installation will- erve: Residence 0 A artment House ❑ Commercial ❑ Trailer -Court [3 Motel C] Other ❑ <br /> Number of living .units: ___I__ Number of bedrooms - --- Number of baths _______ Lot size .......:. . ........ ...� :3. _-•__-__-_ s <br /> Water Supply: Public system ❑ Community system ❑ Private4' Depth to Water Table _:._____ ft. <br /> Character of soil ,to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam` Clay ❑ AdobeV Hardpan ❑ <br /> Previous Application Made: (If yes,date___________ _______} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public-sewer is available within 200 feet.) <br /> �Septic Tank: Distance from nearest well___ t� Distance ffoi-7/foundation--------/0..... G- k --- _ <br /> No. of compartments_._____4aZ.._�.____Size-----�,�__�1{��.Liquid depth----.___. _----______Capacity__ -�t� <br /> Disposal Field: Distance from nearest well-__.Id_�-Dstance from foundation------�Q_�____Distance to nearest lot lin ______s '� 1 <br /> Number of fines----------••-----------------------Length of each line-------•-------70-f----Width of trench-----------Z-//------------- <br /> Type of filter mate ria -------Depth 'of filter material_____/----------Total length_____________e�o------------------ <br /> Seepage Pit: Distance to nearest w�ell----------------------Dista`nncce"—frrom foundation--------------------Distance to nearest lot line__________.-__-. 1 <br /> ❑ Number ofpifs----------------------Lining mete`rial_`---------------------Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.__--_____________________-__________- <br /> ❑ Size: Diameter--------------------------------------Depfh-------------•........... ----------•-------------._Liquid Capacity---•----------------------_gals. <br /> Privy: Distance from'nearest well------------------------------------------------- from nearest building-__-_:__-_-________________________-_--_.. ,. <br /> ❑ Y Distance to nearest lot line------------------------------------------------------------------------- ----------------------------------•------------------------- ---= � <br /> ` Remodeling and/or repairing (describe):-------------- - `- f <br /> - y. <br /> -- <br /> -------------------—-- ------ ---- ------- —------ --- ------------ ---�p-------------------------------------------------------------------.--- --------------------- ------------------ -- ------- <br /> I-hereb certify <br /> that I have repared this a licatio� and that the work will be done In accordance with San Joaquin <br /> um Coun <br /> ordinances, St laws and.rule nd regula ' ns of the San Joaquin Local Health District. <br /> (Signed)----•x•--- 5='`------�` -�/�=� -_ ---- --------------------------------------------------(Owner and/or Contractors <br /> By:-------- ------------------------------- =---­­--------------------- -------------------. -----•--------------------------(rifle)------------------- - . - - -------- <br /> (Plot plan, showing size of lot, location-of system in'elation to wells, buildings, etc., can be placed on reverse side). <br /> x FOR DEPARTMENT USE ONLY - <br /> APPLICATION ACCEPTED BY ��la -- ------------------------------- ----- <br /> DATE-------- <br /> N <br /> REVIEWED BY----------------- -':.----------------------- ------ DATE------------------------------------------------------------ ' <br /> BUILDING PERMIT ISSUED----_-------------------- DATE--:--------------------------- -_ <br /> Alterations and/or recorttmendations:__-` --_.___-�-:'_- " - <br /> S.................. ---- --........................................................---' ...__, --------•------............................... <br /> --/f -- <br /> ' ✓°✓I�.P__�_._.�'tFr\'-__._____ s'--- }Y -1: +- /. !! __-Ir___y!` i4r�--'�- _�1.j____ '�•_.L__:=_-r_"_l1.'!f _______ _________________ <br /> _________________________________ t <br /> FINAL, INSPECTION BY:.. - - - --------- -- -------- ----- --- - Date---- ------ ( ? --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .130 South American Street 300 West Oak Street 4, 124 Sycamore Street 205 West 9th Street <br /> a <br /> Stockton,California Lodi,California \ Manteca,California Tracy,California I <br /> E8-9 REVISED B-59 F.P.CD.1M 6-6D - <br />