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FOR OFFICE USE: <br /> ------------ ------- --3- ------ <br /> ------ Permit No. <br /> APPLICATION FOR SANITATION PERMIT ------- <br /> ------------------ ----------------------- -------------- <br /> --------------------------- ------ (Complete in Duplicate) Date Issued 7 <br /> --- <br /> ------- -------- ---------------- ------------ This Permit Expires I Year From Date Issued <br /> I <br /> Application is hereby made to the San Joaquin Local Health District for a pe'rmit to construct and install the work herein dg"scribed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- Q_Y- P_,$7/70--------4_E, <br /> �------------------------------------------------------....-----------------Il--------------- <br /> ;1, <br /> 1p---------- <br /> 9 --------------------------- <br /> - ------------------ <br /> Owner s. Name____'__Si' --------------- ----------I--------------------------------------------- Phorfe. <br /> Address-----'---_9? ----------------------- -------- ------------------------------- ------------------------------------------------------------------------------------------------ <br /> 1: <br /> ContractorsName--•--------- ----------------- ------�--------------------•----------•----------------- Phone---------------------1!L-------------- <br /> Installation will serve: Residence ❑ 'Apartment House E] Cdmrnercial ffl.�Trailer Court Ej Motel I�Lj Other El <br /> Number of living units:.'-- Number of bedrooms !- Number of baths -1;4- Lot size -------------------i!--------------- <br /> dr <br /> Water Supply: Public system R1***Comm'unity system [I Private El' -Depth to Water Table <br /> Character of soil to a depth of 3 feet-' Sand E] Gravel [] Sandy Loam E] Clay Loam E]. Clay 0_iAclobe gg'-THardpan <br /> ❑ <br /> Previous Application Made: (If yes,date-,--..--__,_..-.--._} No � New Construction: Yes E] No ®—FHA/VA: Yes E]j'. No ZL— <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------------------Distance from foundation-------_----------Material--------------------------------I---------------- <br /> No. of compartments-------------------- -----Size--------------------------------Liquid depf4---------------_ --------Capacity----------------------- <br /> Afoundation.- <br /> - . <br /> , I C�_ <br /> Disposal F!P, Distance from nearest well------—-------Distance from foundation.-7-------Distance to nearest lot line Ji ---------- <br /> Number of lines-------A-------------------- r-Length of each Iine___-jke9--7---------------Width of trench-A---.----.----1t-----.-.--1 ------ 1�111% <br /> -6 <br /> mate .....Total Ien9fh___1PV---- <br /> Type of filter material----- --Depth of filter Distance to nearest lot lie- <br /> Seepage Pit; Distance to nearest well-------- ".-._-_-Distance frow foundation----- <br /> _ <br /> e_AP419WSize: Diamefer._��92;---------- <br /> Number of pits.-.--/-------------Lining material <br /> Cesspool: Distance from nearest weii-------------_-Distance from foundation-------------------Lining material---------------------1!------------------ <br /> ------------------ -------- <br /> 0 Size. Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity gals. <br /> I <br /> Privy: -,.Distance from,nearest well--------------------------------------------- ---Distance from nearest building-----r------------------------------------ <br /> Distance to nearest lot line.--------------- ------------------------------------- <br /> Remodelin and/or repairing (describe):-------------47. <br /> 9 ---------------------------- ----------------------------------I------- <br /> ------------ ---------------------- --- ----- <br /> ----=---------------------------------------------------------------------------------------------------------- ---------------- <br /> -------------------:------I--------------------------------------------------------!------------ <br /> ----------------------------------------------------I-------------------------- -----------A---------------------*-------- <br /> ----- ----------------------------- ----------------- <br /> ---- ----------- - ---------------:-------- I------------t---------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin I: County <br /> ordinances,",Sf ate laws, and rules and regulatiohs of the San Joaquin Local Health District. <br /> _40 -------------------------- (Q*PesmW�er Contractor) <br /> (Signed)--------------------------------------x ------------------ - ---- ----- <br /> i <br /> --------(Title)----iilPs-& ------------ - --------- <br /> BY:----------------------------- -------------•:--------------------------- <br /> (Plot <br /> ---------:---------------------------(Plot plan, showing size of lot, location of system in`r n to wells, buildings, etc., can be placed on reverse side). ill <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_.-- DATE---- <br /> -- - DA <br /> TE---- -- - ---------------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE--------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------_-----------------:------------ =------------------------------------------- DATE---------------------------------------------;�------------------ <br /> 1! <br /> Alterations ---------------- <br /> and/or recommendations:------------------------------ ----------- --------------------------------------------------------------------------------------------------- <br /> ---­-------------------- <br /> --- <br /> ;I <br /> ---- --------------=------------------=------------:------------------- -------------------------------------------------------------------------------------------- ----------------------------------- ---------------- <br /> -------------------------------------- - -----------------------------------------------------------------------------------------*----------------------------------------------------- --------------- <br /> ------------------------------------------------- --------------------------------------1-1------------- -------------- <br /> i <br /> ----------- -------------------------- <br /> --------------------------------------- ............ ----------------------------------------------------- ----------------------------------------- - ---------------I----------------- <br /> ate------------ --- ------------- ---------------- <br /> ---------- -------- -- --- --- <br /> FINAL INSPECTION D <br /> SAN JOAQUIN LOCAL HEALtH.DISTRICT <br /> r may'1601 UNatelton-Av*. 300 West Oak Street 124 Sycamore Str..*, 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,Californi <br /> ES 9 REVISED 8-59 3M 3`63 F.P.120. <br />