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F FOR OFFICE USE: <br /> -------------------------------- <br /> -----­---------------- <br /> --- -------- ---- ------------- APPLICATION FOR SANITATION PERMIT Permit No.' ...�.1_�.:�44' <br /> -- ------- --- ---- --- ------ --- ----- - --------- (Complafa-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued 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. <br /> This application is made in compliance with County Ordinance No..549. <br /> � <br /> JOB ADDRESS AN LOCATION. <br /> -V __ -- <br /> ® I � <br /> --- ----------------------- <br /> Owner's Name MIF.- ; ea �.-----•---•- --•• ------- ---------------------------------------- ------------ Phone.-9 5/d �.. d <br /> Address----------------------V.6-- ---- � = <br /> Contractor's Name----1 wp2 --------------------------- <br /> - - --------------------------------------------- Phone...... --------------------------•- <br /> Installation will serve: Residence Ig Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other j] <br /> 1 r� <br /> Number of living units: -.�.-. Number of bedrooms _.G•.-- Number of baths.-t___ Lot size ----- --- -------- -------- -----_-----..-_.-_-_------.-. <br /> Water Supply: Public system ❑ Community system ❑ Private]K Depth to Water Table"e - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-............. ._ I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> t..� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic T nk:• Distance from nearest well-__- _-_--Distance from foundation <br /> ----- ___--_ 3� .._ <br /> � �Or s No. of compartments-------- ..............Size-- - .-,S ---Liquid de0h....'ed� -- ---.....Capacity--. _00-------- <br /> Disposal Field: Distance from nearest weil..&6j_r._._-Distance from foundation...._/0.......Distance to nearest lot line---A' .. <br /> Number of lines k---------------------------------Length of each line-- ---------------------------Width of trench.---------------------------------- <br /> r Type of filter material._----------------------Depth of filter material-----------------------Total length-------_-__--.-._------_.---------------__ <br /> Seepage Pit: Distance to nearest weff----------------------Distance f-om foundation--------------------Distance to nearest lot line--.-.-..--------- <br /> ❑ Number of pits..:------------------Lining material---------------------- Size: Diameter............. --Depth--------------------------------- �\ <br /> Cesspool: Distance from nearest weld --------- Distance from foundation-------.--------- ..Lining material--- ------------------_-_------ <br /> ❑ Size: Diameter ....Depth------... . --/�-------- ---------------------- Liquid Capacity---.------------------ gals. <br /> Privy: Distance from nearest well______________________________________ ________Distance from nearest buiiding__-__-___-..-.--....._..._-____.____... <br /> ❑ Distance to nearest lot line ...._.-------------------------- ---_fs -------------------------- <br /> Remodeling and/or repairin (desc ije�:__. "_ 4, GAdd,, J61-1 <br /> -. .. -- Y ,_-.� <br /> . .. ' <br /> ..... ... ----- -t <br /> ---- -------- -- ------- ------------ -------------------- <br /> l,herebyYcertify' that I have prepared this application and that the work will be done in accordance with San Joaquin County. <br /> ordinances. State laws,`and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) .lLa..�... / .....(Owner and/or Contractor) <br /> - 0 <br /> "�D_ <br /> Y ;------------------------------------------- -------------------- - (Title) , <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> ! I <br /> a FOR DEPARTMENT.USE ONLY <br /> s • <br /> APPLICATION ACCEPTED B ---. -- - - ----------------------- -------_----- DATE- - �"`- t� '----- , <br /> REVIEWED,BY----------------------- ---- - ------ DATE----------------------------------------------------------- <br /> BUILDING <br /> ---- ------BUILDING PERMIT ISSUED-------- -- -- ------- ---------------------------- ------------------------------ DATE------------------------------ ------ <br /> Alf era'fions <br /> ----Alterations and/or recommendations------------------- t <br /> --- ------------------------------------------------------------------------------------------------------------------- . . - ------ -------------- ----- ------------------------------------- <br /> ----------------- ------ ----------- ------- -- --------------------- <br /> .-• --•--- .. <br /> -- - -FINAL INSPECTION BY:--- --- --------------- - - -------'---- --- Date-- - --------------------------------------- --------------------- <br /> r <br /> , • SAN JOAQU.IN'LO.CAL-HEALTH DISTRICT ' <br /> 1601 E.Hazelton Ave. i.300 West Oak,Street 124 Sycamore street 2Q5 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy;California <br /> E.H.9 2M 1-67 Vanguard Press <br />