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............ ... ------ APPL DTION FOR SANITATION PERMIT Permit No. ._ -----a)x <br /> ............ <br /> (Complete in Duplicate) Date Issued --- b, <br /> This Permit Expires 1 Year From Date Issued <br /> lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I scribed. <br /> `` pp y q <br /> his application is made in compliance with County Ordinance o. 549. <br /> }CB ADDRESS AND LOCATION __l__ G -. -- --- 1 -.-'�' `" ``-' --------- s <br /> Owner's Nam e------� --------------I&-'----�t�--�= -- - �----'-�. - - Phone....................... ----------- <br /> - <br /> -----•---- <br /> ' ---. --•-------------------•-----••--•---------..__. .------------ <br /> � = =__ <br /> [ddress .............. Phone. <br /> ontractors -- <br /> stalls{ion will serve: Residence ❑ Apartment House ❑ Commercial Frailer Court ❑ Motel ❑ Other <br /> Number of living units: -------- Number of bedrooms -_. ___ Number of baths ........ tot size ------------------------------------------------------ <br /> - --•- <br /> Water Supply: Public system ElCommunity system Private[fl DeZClay <br /> Water Table -------- ft. <br /> 17-haracter of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> I. 4 <br /> _:evious Application Made: {If yes,date.------- -_...1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 280 feet.) <br /> `-3eptic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material---------------:-_ _.-_.___..___._....._.__. <br /> ❑ No. of compartments------------- ----- -----Size-------------. ----------------Liquid depth............... ' ' Capacity--.---,-....... ------- <br /> ,isposal Field: Distance from nearest well................Distance from foundation--------------------Distance to nearest lot line_.______•_____._. <br /> Number of lines---------------------_-------.- -Length of each line--------------------------__Width of trench..----------------------- - _ <br /> /Y Type of filter material-------------- f.._Depth of filter material__.---------.-------..Totallength-----------.-_______--_____._-_.:_.__--_. _ <br /> sf <br /> Distance to nearest well----�d�G`._.____Distance fr f dation :_._..-_-_____.. <br /> Distance to nearest lot line,,-::7___________ <br /> J. <br /> ❑ Number of pits...-.--/-__..__--__Lining material. _ ------------------ L <br /> esspool: Distance from nearest well-----------------Distance from foundation---------------,----Lining material---.._............... <br /> _.__.__.__.._.__. `l <br /> I ❑ Size: Diameter----------------- --- ----------------Depth----------_------------ ---------- ---------------Liquid Capacity- -----gals- <br /> Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El <br /> __._....._..._._- _____-__...._..___.❑ Distance to nearest lot line------------ -------------------------- -- - -------------------------- --- ----••---------------------- -----------'----------- <br /> i �'•emodeling and/or repairing (destnbe)-----------------------------------------'-'------•--------•----------------------------•---•-----•--•-•------.•---' •------'----'•---------'--------..... = <br /> ----- --------•---------------------------------•--•-------------�. <br /> i <br /> F ' - ------------ -----•-•-------•-------••------------------------ ---------------- --------•----------I----- ----------------:----------'----------------------- -----------------*-------------------­­­-------------- t <br /> I hereby certify t t 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State la , and rules and regulations of the San Joaquin Local Health District. <br /> � <br /> ..­40-0" /or Contractor)igned).-------- ----•-------- ---------------------S -----= <br /> --- if/ :_�� _... --------(Title)--------- --- --- ..............:...... <br /> lot plan, showing size of lot, location of system in relation to ells, buildings, etc., tan be placed on reverse side]. <br /> t <br />�, FOR DEPARTMENT USE ONLY <br /> t\PPLICATION ACCEPTED :. ------------------------------------------ ---- DATE- =...... ---•-•----- ------------ ' <br /> I 'EVIEWED BY...-'--- -------------------------------------- ------ -----•----------- ----------------------------------------------- DATE---- ------------------ -------------------------------- <br /> ' <br /> BUILDINGPERMIT ISSUED----------------------- i-'•-------'--'-- . DATE---------------------------------------------- -------------- <br /> Iterationsand/or recommendations:----------------------------- -------- -------------------------------------- --------------•--- •------•---•------•--------------•-------------------------- <br /> i <br /> •-•---. •.......---I ....... .................. -- ----- - --- ---- -- ----------------------------- <br /> - <br /> ----•---------- <br /> ------------- •----------...-... :_._......._._...---- " " ' <br /> Date... ` ' ' :._..i:...✓._._....... <br /> FINAL INSPECTION BY::" ='- '..............---.------- -=----- - ' ' ......... <br /> i, SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E,Ha:ellon Ave. 300 West Oak Streel 124 Sycamore Street 205 Wes$9th Streit <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P-Qa. r <br />