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FOR OFFICE OUSE: , <br /> - - --- ----- <br /> -------------------------------------------.-----------.- APPLICATION FOR SANITATION PERMIT Permit No. - 4- Y::.._I_Z <br /> --- ---- ------ (Complete•in Duplicate) <br /> _._.. Date Issued This Permit Ex fres 1 Year From Date Issued 2 <br /> 7—?- 2-.5,0--Te <br /> Application is hereby made to fhe.San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> `.? .�O ADDRESSAND' LO A i St I ® " �D� ` E� t <br /> This application is made in compliaruce with County Ordinance No. 549. <br /> �. E' f-t!�-f•c�� ' j'z.0 <br /> _C T <br /> ---- --------. ---.----------- ----_. <br /> J t .. . <br /> Owner's Name------------- •al _ ..... /fir's------- <br /> ------------------- --------------- --- --------------- -._ Phone------------------------------------- <br /> Address------------- <br /> -- • ----• -----------'----_--- <br /> Address----------------- <br /> Contractor's Name------ -•--- O'W­l['F_{;Z_1-----•-- ---------•-••------•---------- ------- ------r-------------------------------------- Phone...... --------------_............. <br /> Installation will serve: Residence ®—Apartment House ❑ Commercial/['-] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _._._ Number of bedrooms __2--Numberfof'baths __�.._ Lot size __-kcRFP_5� ------------------- �q <br /> Water Supply: Public system E] Community system El Private Depth to,Water Table 7U- ft ; <br /> Character of soil to a depth of 3 feet- Sand ❑ Grave! ❑ Sandj Loam ❑ -Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan el <br /> j Previous Application Made: (If yes,date-.....------- No 2 .�'Nj1,ew Construction: Yes'-L No 2--FHA/VA: Yes ❑ No B' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , <br />'- _ ��`�°(No�septic tank or cesspool permittedrif`=pub'lic=sewer�is avarlabte�wi+liiin�200tfe�t:�` �` - - - - - <br /> Septic Tank: Distance from nearest well------------------ from foundation________________._.Material ----- ----- -- __ ._____-_____...__--__-.. <br /> ESTt�11� No. of compartment=---;------------ - f/{_Size �--- -y�----- -. -� _iL-'iquidi'depth--------- - --- --------Capacity------ ------------ <br /> fDisposal Field: Distance from/nearest,weft:_,:._ _._,f_....Distance from foundation________________._.Distance to nearest lot line________________ <br /> ���"i'-i tV��a- Number of lines r�-`-4'-'-,=`.�'=-`---:---'-----Length of each fine--..---------------------------Wid#h of trench.--------------------------------- <br /> Seepage Pit: Distance to nearest well_.__1•090____---Mstan �y <br /> fr ' Type of filter material__._.__ ......_S..Depth,of filter material___-------------- Totals length_________________________________________ <br /> ce fro foundation____ /_____..Distance to nearest lot line-_____- ______ <br /> Number of pits.-1.- �-------------fining material: G - Sizei"Diartiefe'r`_ X _..__Depth-../Z.-`.--�_ ------- <br /> cesspool: <br /> ----.--- <br /> " Cess ool: i m f unciation._________________Linin <br /> p Distance from nearest well . .............Distance from 7- 9 materia!--------------------- <br /> .______________. <br /> ❑ Size: D;ameter_ .� -------------- - -------------Depth----- ``-- ------------Liquid Capacity------------------------ • gals. <br /> Privy: Distance from nearest well------ ___________________________________Distance from nearest building______---.- <br /> ❑ Distance to''nearest lot line�- -- --------------------------------------•-----------------'---------------------`----------------- --------------- ------------------- i <br /> Remodeling and/or repairing (describe):----- ----=------------------------------•--------------------------------------•---=------ --------------•---------------------- - <br /> ;i <br /> ------------------------•-•-----•----------------------------•---------- <br /> t ;I <br /> ------------------------------------------------------------ --------------------------- ------------------------------- <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. E <br /> (Signed)---",! 4" �.1 #Yr r•"� = (Owner and/or Contractor) <br /> - <br /> (Plot plan, showing size of lot, location of'Ve r�i in relation to wells, buildings, etc., <br /> can <br /> placed'>o�n reverse side). <br /> S'l F i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---=---_-,__1\_`L_"_'----------------- - <br /> ----- ---------------- ----- -----------------._ DATE.- ---•�------��--'- �� <br /> REVIEWEDBY------------------------- ------------- --- ------------------------------------------- ----------------- DATE----- -- <br /> BUILDING <br /> BUILDING PERMIT ISSUED-------- --- _------------ --•----------------------- ------------- DATE - <br /> Alterations and/or recommendations:--- -•-- <br /> ------------------------- ---- ---- <br /> ------------------------------------------------_- w _..-_... -..__. _ -----•---------•-------------- ----- - <br /> ' ---------- ------ -- - ------ ---- <br /> ---------------- ------------ :. <br /> ----- - - --------- ------- ------------1 - <br /> dr <br /> FINAL IN- - Date_ -T---- ---- -- ... --{-'Y= <br /> -,---;•-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracyr California <br /> EM,9 2M 1.67 Vanguard Press - <br /> 5 <br />