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'F OFFICE USE: <br /> L <br /> --------- �=�'� <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._�.3._---------- <br /> (Complete in Duplicate) "Date Issued ..- -.---� � <br /> This Permit Expires I 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.This application is made in compliance with County Ordinance No. 49. <br /> JOB ADDRESS AND OC TION ._ <br /> [_° -------------------------- ------------ --•-••---------- --------------------- <br /> y 630 -- <br /> Owner's Name_`----------=----- -------------- -----••------------------------- -- - <br /> Phone - . <br /> Address ..__ -------------------------------------------------------------------........-------------------------------- <br /> -- <br /> -G-/1 .._.. -----•---------- Phone_ { <br /> Contractor's Name-----�--------------------- - - ...---�----------'---------�---•-------------•---- �- <br /> Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ----- -- Lot'size ----/ <br /> 4r ------------• <br /> a <br /> Water Supply: Pub€ic.system Community-system [_1Private [IDepth to Water Table/S_ it. <br /> 3 <br /> Character of soil to a <br /> depth of 3 feet: :Sarid � Gravel ❑ Sandy Loam El Clay Loam [3Clay,❑ Adobe❑ Hardpan ❑ x f <br /> s _.__..7 No ❑ New.Construction: Yes No ❑k FHA/VA: Yes ❑ No ❑ .' <br /> Previous Application Made:. (If yes,date--_.__'.__ - <br /> # -tea ... :� r # <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: # <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee <br /> _ Material. ---------------------- - - ------ <br /> Septic Tank: Distance from nearest well______ ____ _____Distance /-- _ - <br /> Li uid de th �/ Ca actt 4�J - ---- <br /> No. of campartmenfis_ —•.-.n 1 Size_ _ q rP, - _/­_----------- P y--- -- <br /> Disposal Field: Distance from nearest well-C�4Y /-Distance from foundation__ 4-.-_-------Distance t0 nearest lot line____- <br /> r a <br /> y .......... s�r <br /> Number of lines_______s _____ Length of each line____d____��a_ Width of trench-_; _ ___ <br /> . - 4.. <br /> Type of filter mate_rial_ '_t'/�[}_Gr ._:€Dept€i of filter material---- length________________ _____ld-- � <br /> Seepage Pit: Distance to nearest well---------------------iDistance frorn foundation---------- to nearest lot line--------- -------------- <br /> Number of spits----=-----------------Lining material-- ------Size: Diameter-----------------------Depth <br /> Cesspool: Distance from nearest;well_.______-____._-Distance from foundation_____----__________Lining material___._______-______.___-__.______.__. <br /> I <br /> ------Depth-----------------=----------------------------------Liquid Capacity----------------------------gals.. <br /> ..❑ Size: Diameter--• �-�--------- --------�- - <br /> I Privy: Distance from nearest.well-----______________------------=---------------Distance from nearest building____.----_______-------.-------------- -- <br /> ❑ ,' Distance toy nearest lot line---------- ----- ' - -' ------------------------------------------------------ <br /> __ . L�A = `= <br /> ! Remodeling and/or repairing (describe): �---------- - t <br /> ------------------------------------------------ ------------- -- ------- ----- <br /> ---- ---- at.................. r--- r r <br /> -------------------------------------------------------------------------------------------------------------- <br /> hereby certify that I have preparedAis application and that the work will be done .in accordance with San Joaquin County <br /> ordinances Rte laws, and rules and regulations of the San Joaquin Local Health District. . <br /> R. 1 / C t <br /> ---- --- - ------------- -- net and/or on ra <br /> Ow d o ctorl <br /> gY --------------------------- d --------- =(TiTiel------- --- ------------------- ------------ <br /> _ 1 <br /> (Plot plan, showing size of lot, location'of sysFemin relation to well uildings, etc., can be placed on reverse side). <br /> t FOR DEPARTMENT USE ONLY . ' <br /> ' 4 <br /> APPLICATION ACCEPTED BY---- • `- -_ DATE----9=-1 -� --•---- <br /> ------------------ <br /> ------------------ <br /> ----- <br /> REVIEWED BY--------------------------------------------- DATE <br /> = ------------ <br /> r DATE. -------•. <br /> BUILDING PERMIT ISSUED------------------------------j`-- -------------- <br /> Alterations and/or recommendation$:- �- J---"' ti-- --•--- ------- --- *-� ' <br /> -----------------•--------- <br /> -------- <br /> ______________________________________ <br /> d• _______________________________________ 4F-rte <br /> _..__.._--.__________________________________-________.---___.___.___-__.________._-_--.._______ -1 <br /> --- <br /> .. ----- <br /> --------------------------------_r - - ..........•---•--------- -..._-- ----------- <br /> (( <br /> �--------- <br /> ---------------- ------ <br /> Date-_ ---- ---------------- <br /> FINALINSPECTION BY:- --------- -------------- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT, W <br /> 1601 E.Hazelton Ave. 30o West Oak Street 124 sycamore Street 205 West 9th Stree, <br /> 9 <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r <br /> Es 9 REVISED 13-S9 3M 3-'63 F.P.CD. <br />