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FOR OFFICE USE: <br /> -- / <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. .._!..-�?...(_...I"..� <br /> --------------------------------------------------------- <br /> (Complete in Duplicate) f <br /> Date Issued ._..-6121 <br /> ------------------------ - <br /> -------------- --- This Permit Expires 1 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. <br /> This application is made in compliance with County Ordi ce No. 49. <br /> JOB ADDRESS ANDCCATION---YI�-- -- ----- ------ ---- -----_ f L-- <br /> Owner s Name ----- -- lJ �11:.' ►� <br /> Phon 7.%- _-3- <br /> /� --------•--------------- --- <br /> Address- /�]jam ® <br /> Contractor's Name_--f1..4 __. Phoni'--�?- 7 <br /> Installation will serve: Residence ❑ 'Apartment ouse ❑ Commercial ❑ Traooiler Cog ❑ Motel ❑ Other �� <br /> Number of living units: -------- Number of bedrooms -------- Number of baths <br /> ;&A;6 <br /> size ------I-& <br /> •- l r� <br /> Water Supply: Public system ❑ Community system ❑ Private T---D',pth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan C-]Previous Application Made: [If yes,dote-------------- -) No E] New Construction: Yes F1 No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S Distance from nearest well-_-.--_-.-------Distance from foundation---------------_--.Material-__-------------------_.---__-_-_-------------. <br /> No. of compartments-- -�� ------Size--------------------- ----------Liquid depth---------------- --------.Capacity----------------------- <br /> Di �[ Distance from nearest well.lE'�Q.f----Distance from foundation----- to nearest lot line-----/J-� <br /> Number of lines_____ ______ _ ___/_... _ _--- _Length of each line------ - -------.Width of trench____A__ ��______.___._._ VV <br /> t� epth of filter material-_--.--1Q_°�. Total length-------------------�4P�---------_ <br /> Type of filter material- f - 6 <br /> Seepage Pit: Distance to nearest well----_----------------Distance from foundation----_-_-_--_:^"Distance to nearest lot line----------------- <br /> ❑ Number of pits.---------------------Lining material--•------ ------------Size: Diameter---------- ------------.Depth--------- ----------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------- -_-- <br /> ❑ Size: Diameter---------------------------------- ---Depth-------------------•--------------------------------Liquid Capacity----------------------- 9als. <br /> Privy: Distance from nearest well-----_------------------------------------------Distance from nearest building------------------------------------------ 0 <br /> ❑ Distance to nearest lot line------ ---------------- ------------•--------------------------------------------------------------- <br />` Remodeling and/or repairing <br /> i <br /> (describe):------------- r <br /> --�--------------•------------------ <br /> : L 1_8:: __::_ ______:r _ __=�___ _ ___ ____ 0�______ __ ----------------------- ----- <br /> QQ <br /> - - <br /> I hereby certify that I have prepared this application and that the work will a done in accordance with San Joaquin County <br /> ordinances, State laws, and rules -an1d regulations of the San Joaquin Local Health District. <br /> 1 �—-� R NA-q �/�, (�r Contractor) <br /> • --- Title --- --- <br /> --------------------------------------- (Title) <br /> (Plot plan, showing size of lot, location of system in relation to we , buildings, etf aan be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -a-- ---------------------------------------- DATEI -Z-`r-- P�------------------------------ <br /> IREVIEWED BY------ DATE-----------------------------------------•------------------ <br /> BUILDING PERMIT ISSUED---------- ------ <br /> sr- ----------------------------- --- DA- E-- -- ----------- --- <br /> -- -------- ---- <br /> Alterations and/or re mmendations:__.�.._ <br /> '`^7<` <br /> - 7G _ <br /> ­& ---- <br /> 2'v✓-- ---- ------ - -- ---- ------------ - -- <br /> -- r <br /> --- -- ---- - <br /> --- <br /> 'tom--'-- -- ��� ,�...- <br /> FINALINSPECTION BY------------------------------------------------- --------------- Date-- ----------------------------- - ---------------:":=----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 4 REVIS EO B-59 3M 3-'63 <br /> �1.r <br />