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FOR OFFICE USE: <br /> "p-) <br /> / o, <br /> -7- '7 2& <br /> ------------------------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit <br /> --------------------------------------G._.---_..__-__----0- <br /> ------------------ ----------------------- —_(CoTpl�fe,in, Duplicate)-,:,, <br /> --- -------------------------------------- F P Vn�bat Issued <br /> Date Issued ---- <br /> i rmit Expires I W'e�b'r'Fio e ssue <br /> Application is hereby made to the San'l?a 'in Local Hiadl*Y District-for permit to con0r.uct and"install the work herein described. <br /> " <br /> This application is made in compliance f County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.------- --- ---- ---- ------------ ------------------- <br /> ------------------------------------------------------------------ <br /> Owner's Name ------ ---------------------------------:----------------------------------------------------- -------- Ph6rie---------------Address.. : <br /> ------------ ­------------------ ------- ---------------------------------------------:-------------------r......... ------I-------------------------------------------------------- <br /> Contractor's Name______ - -- --------------------------------------5:------------------------------------------------- Phone_____________________________ <br /> Fm--'7 <br /> Installation will serve: Residence ------ <br /> ®!Apartment H El 1,C-ommercial ❑ Trailer C6urt E] Motel 0 Other <br /> ...Number of living units: Number of bedrooms.-A.-Number of.,ba'ths__al- Lot 1size.-MkZA4�....------------------------ <br /> 11 <br /> e <br /> Water Supply: Public system 64munify system El Priva te ❑ Depth-fo- -ater Table <br /> Character of.soil to a depth,of 3-f I 6t: Sando Gravel [j Sandy Loam E] Clay LoamO)Clay 0 Adobe g], E lardpan [] <br /> 'Previous',kpplicaf ion Ma;ge: (if yes,date--------------------)r No P3— New Construction: Yes E] No ❑,-FHA/VA: Yes ❑ No Zj— <br /> TYPE OFINSTALLATION ,ANb SPECIFICATIONS: <br /> ..(No septic tank or cesspool permitted if public sewer is available within 200 feet.), <br /> Septic Tan6: Dis1_ance from nearest well-________________Distance from foundation---------------------Material----------------------------------------........ <br /> Allf 'No. of compartments---------- ---------------Size--------------------------------Liquid depth----- --- --------------Capacity----------------------- <br /> Disposal <br /> -----Capacity----------------------- <br /> Disposal 'Field: Distance from nearest Distance from foundation----_------------ Distance to nearest lo e________•_,_----_'_-_-_.A 0�1 <br /> 0 <br /> ,C-1, Kumber tbf-lines- tee-h-gFth-,5f'ea cl-f-li-n Width of trench_ <br /> Typeof <br /> filter material_,_ --.---Depth of filter material-1/e -------Total length- -- ----- ----- <br /> See Distarrce��h-ea rest I <br /> .�age Pit: r D�stance'to ne6rest well----------------------Distance from foundati6h_­ o ne------- ----- <br /> ZVI�V/# tp.",Li f .4 <br /> mber?'c) Pt,.S--I -----------------Lining material-----------------------Size: Diameter------------------------Diipth----------------------------- <br /> Cesspool- Distance from i1e'arest 'w':6111-----------------Distance from foundation--------------------Lining material------------------------------------ <br /> k . <br /> F / <br /> Si'ze' Diameter---------)----------------......... Depth--------------------------------------- -----------Liquid Capacity........._----------------gals. 0j <br /> Privy. Y Disfance!from nearest'All-------------------------------- ------------- ...Distance,from nearest building-I <br /> ---------------------------- <br /> ---- ------------- --------------- ------------------­­------------------------------- <br /> Distance to nearest-lot line-T- v-------------------------- <br /> Remodeling and/or' repairing (describe):--------------- --------------------------------------- <br /> ------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------1�p------------------------------------------ ----------- <br /> -------------------- <br /> ---------------------------------x--------------------------------------------------------------------------­­­----­------­-------I----------------------------------- ---------------------------------------- <br /> ------------------------------ ------------ ---------------------------------------------------------------------------------------------------------------------------------- ------------------- ------ <br /> -------------- <br /> I hereby certify that I h�'ve!prepimTthis application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State,laws, anjjules-,and reg u tions of they San Joaquin Local Health District. <br /> t <br /> " <br /> d L <br /> (Signe )----------- --------------- <br /> I "_a`14/or Contractor) <br /> ------- --------------------------------- - - - ----- - .................... <br /> By:------------------------------ --- -----------7 ------- -----------------(Title)- ------I....... <br /> - <br /> (Plot plan, showing size.of lot"location of Sys in relation-to-w.ells,-buildings,_etc..-can-be-Pla oed_onjexerse.side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEQ BY_.___-_._ --------------------------- <br /> -------------------------------- DATE_____---_ --------------------------- <br /> REVIEWEDBY -----------------f-------- ----------------------------------------------------------------------------------------- DATE--------- ---------------- --------------------------------- <br /> BUILDING PERMIT ISSUED-V---------------------------------------------------------------------------------------- -------.- DATE--------- --------------------------------------------------- <br /> Alterations and/or recommendations:------- ----------------------------------------------------------- <br /> ---------------------------------------------------------------------------- --------------- <br /> -------------------------------11------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- --------------------- ---------------------------------I------------------ --------------- -------------------------------- ------•-------------------- -------------------------- ---------------------- <br /> ­-----------------i------ --------------------------- --------­-------------------------------------------------------------------------------------------------------------------- ----- ----------------------- <br /> ----------------- -------------------- - - ------------------------ ----- --------I—------------ ----------------------------- <br /> FINAL INSPECTION BY:_ - ------------- ------------------ Date-_ Y�7�_4-1�z7—--------------------------------- <br /> SAN JOAQUIN-LOCAL HEALTH DISTRICT <br /> X� <br /> 7601 E.Haiphiih ve 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, Caiifornid= Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 3M 2-'63 F.F.00. <br />