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'�; OR OFFICE USE: <br /> w <br /> = ----------A' - Q <br /> =—-- Permit No =- <br /> - ------•--- <br /> APPLICATION FOR SANITATION PERMIT 7 <br /> (Complete in Duplicate) .�" <br /> --- ------ ----------- -----_- -- --- <br /> Date Issued <br /> --------- This Permit Expires 1 Year From Date issued <br /> Application is hereby made'to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> " <br /> : � <br /> ----- Q z' '— ----------------------------------------- <br /> JOB <br /> ADDRESS AND LOCATION ` ------ --- ---------- - ------- --- --------- <br /> j <br /> ----------------------------------- <br /> : one. <br /> Owner's Name-.--- --- _ -------- ------------------ - --- -- ----------- Ph <br /> I f <br /> � ---------------- ----------------------------------------------- <br /> t Address------- cPhone_________"_"""-__"""_ <br /> Contractor's Name--- <br /> Installation <br /> will serve: Residence ❑ AP nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Pther C ! <br /> Number of living units: __-- Nuerof bedrooms ._".__"" Number of baths _"" -_ Lot size __"_______ _-"._" _ <br /> Water Supply: Public- system �ommunity system ❑ Private [:] Depth to Water Table .2-j1 ! <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�Hard.rr <br /> 4• p �°«. <br /> Previous Application Made: (If yes,date---------------------1 No (] New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No C� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i SepLt-1i�c Tank: Distance from nearest we "" _-. . - v rom�- o <br /> n ating � - <br /> 7� ` - quideth-----------/11� --1C <br /> a acitY <br /> No. of compartments--------------------- - - L <br /> -- <br /> f <br /> r­f <br /> Disposal Field: �Distance from nearest well. ".-Dis <br /> tante from foundation--�C--"-/ji�lf._�_.-f--.--Distance to nearest lot�li.ne_--7 --,- <br /> -- <br /> Q <br /> Number of lines------------------/---- ------- --Length of each line----------- i. ---Width of trench- --y Y ------ <br /> th_: ____ _-- ____-_Type.of filter.material----lid( rmaterial_____" Total OengDepth.of filte 'r <br /> Seepage/Pit: Distance to nearest well----------------------Distance from foundation_.:.-----_-.-.----_-Distapce to nearest lot lii� <br /> l -------.Depth__..---------------------- { <br /> Number of pits material--� _. __,Size: Diameter_ _ --._ <br /> Cesspool: Distance from nearest well-- -------------Distance from foundation'..._.---------------Lining material----.-.--.-_------__-----_--..--------# <br /> El Size: Diameter- ----- ---<---- ------------- ---Depth---------------------------------t----------------------Liquid Capacity------------------------------ <br /> -----=_ --------: als. <br /> gals. <br /> k <br /> _----•---:_-•.-___------•-----""- ----Di Dista se from nearest building------------------------------- ------- <br /> Privy: Distance from nearest wellM <br /> f0 Distance to nearest lot line-----------------------------------r---------------- ------------------------------------------------------------------------- <br /> - G <br /> Remodeling and/or repairing (describe)--------------------- --------- •---------------------------------"--------------- ---------------------------------------- <br /> ----------------------------------------------------------- ----------------------------------------------------- ------------ <br /> I <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 s, and rule qndere"lations�ffhheSaaquin Local Health District. <br /> ti -------- (Owner and/or Contractor) <br /> (Signed)" I ] <br /> --- <br /> ---------------------(Tit ------------------------- <br /> By:---------- e -- . <br /> ------- ------ -- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, eta, can be placed on reverse side]. <br /> E FOR DEPARTMENT USE ONLY { i <br /> —� - <br /> DATE <br /> APPLICATION ACCEPTED - --- ---�1-=��r------- ----`�-t------------------- <br /> IREVIEWED BY----------------------------------------- ----------- DATE-------- ------------------------------------------"------- <br /> BUILDING PERMIT ISSUED-----------------------•- --------�------------A---- ------------ ---" ------ <br /> TE------------- - -------=---------- <br /> Alterations-and/or recommendations: _-__ _ ---------- --- --- •" � �`��� ` <br /> I4j ti. r'�``jam'c'Y'�` �[' �`-.`` z`�rc <br /> ---------- = ------ <br /> ----------- <br /> --- <br /> ire --- --- <br /> pC.��-�� -- ----- ---------- - <br /> y� <br /> /1 1 1 (� <br /> FINAL INSPECTION n A <br /> ` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-•63 F.P.120. - J� <br /> j <br />