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rur,vrrlC.k USE: <br /> 7 <br /> f <br /> -------------------------------- - <br /> -----� Y ..�__ -- APPLICATION FOR SANITATION PERMIT '"/ Pe rmit No. <br /> ,._. " _ <br /> (Complete in Dtiplicafe) -` <br /> ------------------ This Permit i x fres 1 Year From DatIssued <br /> - e - Date Issued <br /> T//T1l/ A plJc�aption is hereby ma b 4b_1he San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. <br /> N aP l cation is made m compliance. with County Ordinance No. 549. ' <br /> JOB ADDRESS AND OCATIO / 11/ r <br /> Owner's Name <br /> ---------- ---------------- <br /> Phone <br /> Address <br /> --------------------------------------------------- <br /> Contractor s Name--•__--•- • --- _ _ � •- ----------•-----•---•. <br /> d1 <br /> -- --------- --- - - ---- ---• --------------------------------------------- Phone---•--•-----•----------...-------- <br /> Installation will serve: Residence42---Apartment'. <br /> t %' <br /> '®'�Apartment�House ❑ -Commercial [] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __( Number of bedroomsNumbersof baths <br /> '2—__ Lot size _ _,,�( (�---------------------- <br /> Wafer <br /> Supply: Publics stem �ommunif system Y Y' Y ❑ Private ❑ '`De�th to Water Table <br /> Character of soil fo a depth of 3 feet: Sand ❑ 'Gravel ❑' San -y Loam ElClay Loam E] Cla <br /> y [IAdobe ardpan [] <br /> Previous Application Made: (If yes,dafe__________ ________) :No New Construction: Yes No ❑ FHA VA: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:_ / [I No <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic TDistance from nearer± well-_ --Distance from foundation__/ h <br /> No. of compartments_ ____- �/ <br /> / -�-. Materia - -l- _�D___---- <br /> - Size__. -----Liquid depth--- �2 Capacity-- - -Gs <br /> Disposal F Distance from nearest 'well------ <br /> ---------_Distance"from'toundatio ______ <br /> r1f------ _ Distance to nearest lot line-: ------------ <br /> ------- <br /> f-_ <br /> Number of lines------- ------- <br /> �- ep `�----Total __-� W <br /> See a e - j <br /> p g Distance to nearest weft _ --_Distance�m four}Qation--_�- /----,Distance to nearest lot line_.__ <br /> Number of its__:__ _.__ <br /> p �- =:__..Lining material__-_ . _Q_G-_ ---Size: Diameter.__ � <br /> Cesspool: Depth ?:f�- <br /> p D stance from nearest welt----------------- _ _ <br /> Distance from foundation_._ ___---- -----.Lining material__------_-------_______------------ <br /> ❑ Size: Diameter -----------------------------Depth---------------------------- <br /> --------------------L�.qu-icl. Capacity-- -------- <br /> ---------------gals. � <br /> Privy: Distance from nearest well_ ________---- <br /> -----Distance from nearest buiiciin <br /> ❑ Distance to nearest lot line----------------------- g --------------------------- - <br /> --------=-- <br /> -)5 <br /> .�.. w._. --------------------------------- -------- ---------------------------------- �----- <br /> Remodeling and/or repairing {describe]:------- � <br /> . ._ <br /> ------------- ------------ <br /> ------- <br /> --------------------------- <br /> -------------------- <br /> ------------------------------------------- <br /> her - ertif that ihave------------•-----------------------------------------------------------------•---------- ----------------------------------------------------------- - -------- <br /> Y prepared this application and Aaf the work will be done in accordance with San Joaquin County <br /> ordinance{, Sta laws, aarues regulations-of-fhe San;leaquin-Local-Healtlr'-Disfrie"t:(Signed] ----•- ---------------- <br /> ------------ ---------------- ------------- --------------------------- ----{By------------------------ O ner and/or Contractor] <br /> w- --{Plot plan, showing size on V_ 1Wy;em:V_r711V1R"n to wells, buildings etc:, can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> 4 <br /> APPLICATION ACCEPTED BY ? <br /> r - -------- DATE - / <br /> REVIEWED BY ...... <br /> ---- ----- - ------------------- -- -- ' <br /> - ----- ---•----- � ------ <br /> -------------------------------- ---- DATE_--------------------- <br /> UILDING PERMIT ISSUED - �------------------ <br /> _ _. `' �TE.__ <br /> ------------- <br /> Alterations and recommendations ---_Y "--------------------------------------- _.-_._. <br /> T <br /> t <br /> ---------------------- <br /> / i� <br /> --------------- ------------- <br /> --------------- <br /> ------------------ --------------- <br /> ------------- <br /> ----------------- <br /> FINAL INSPECTION BY:_.... Date <br /> k <br /> .(/ -------------- L <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haxelfon Ave. 300 West Oak Street <br /> 124 sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> l F.a.eo. <br /> 1 <br />