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FOR OFFICE USE: <br /> ..................I--------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ............................................... <br /> .......................V._.........-....... ........... (Complete in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit .0,CV;UOt-.,0ndTinstall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> .............. <br /> ....................... <br /> JOB ADDRESS AND LOCATIOI`,L ...... .... ............... <br /> ...... Phone----Xe6 <br /> ........... <br /> Owner's Name._. ......................................................................... <br /> Zov------- ------- -•---•------------------•--------......._.f 0 f........................ft <br /> .............. <br /> Address. - ----- ----_4 ---------- <br /> .......... Phone-Y nv.�. _44e7 <br /> Contractor's Name="......... ... .. ------------- ........ .00 1 <br /> willI I Court E] Motel 0' Other El <br /> Installation serve: Residence:9 Apartment House [:] Commercial E] Trailer C I,- — <br /> -"0_40,0_0.. --------- <br /> Number of living u i S: ... Number of bedrooms .3._ Number of baths -/-. Lot size <br /> rWafer S4PPIY: tPublic system El Community system [:] Private Depth to WaterMable <br /> Clay.Lioam,[:] Clay [3 Adobe 0 Hardpan,E] 11 <br /> ]—G r a*v,*e'll ❑_s:a�n -;-LO;MN( y <br /> `I Character of soil to a depth of 3 ­­ d <br /> Ar feet: Sand N [j Now Construction: Yes E] IN PHA/VA: Yes ❑ No []'i <br /> Prbvious Application Made: (if yes,date----; 7--------)` 6 OX <br /> TYPE'-OF INSTALLATION ANDI SPECIFICATIONS: <br /> J� e— � : p4blic' <br /> (No, ic.+ank:-or cesspool. permitted if .sewer is-available within 200 <br /> - <br /> e- M777� ateriai................................................. <br /> Distance from nearest well_........_.7�....Distance from founclation............. <br /> ep <br /> 4-T <br /> ? e p�h...............___------Capacity.__................ <br /> No. of compartments_-- ---------------------Siz --------------------------------Liquid ode <br /> st lot Iine4AA___.) <br /> Disp spi 61d: Distance from nearest w-ell-6-4)-........Distance from fbunclation--- ........Distance to nearest <br /> Number of lines.._/ Lerngth of each 1,!ine_1_&.0...... .........Width Width of trench_a... <br /> 00 <br /> Type of filter ma ... .................. ...............V. <br /> ferial Depth of filter rnaterial..... Total length. <br /> dation....t..............Distance to nearest lot line....1 <br /> ............. <br /> Seepage Pit: Distance to nearest well......................Distance from foun <br /> Number of pits.............. -------Lining material...............I -_.Size: Diameter.......... .............Depth---------------------------------- <br /> trial................... ............ <br /> Cesspool- <br /> Distance from nearest well_________________Distance from foundation ...............1ining mate <br /> ❑ Size: Diameter-----------4 1Depth.----- 7_. do <br /> ­............. ••---••••t-----------:•-•--- ...............Liquid Capacity_-_-_----------r ga S. <br /> ...........7.- <br /> Ll <br /> ell—---------­---------------- ...Distance from nearest building. -----------------------4.......... <br /> Privy: Distance from nearest <br /> ........................ <br /> .............................................. <br /> Distance to nearest earest lot line.__'_."---------------------I----------­----- ------ ................. <br /> 0 .. .......................................... <br /> Remodeling and/or repairing (describe):_..457- -.4 <br /> ---------- --------- - -- ----------------- - --------- - <br /> ---------------------------------------- ----------­.... ... ....................... --------------------------------- <br /> ........................................................................................ <br /> ............................................................................................­_­...............................................:----------------- <br /> ........................ ........................... I <br /> qr. � I ................................. -------------- -------------.......---------------- .......... <br /> ....................................................................... <br /> ­----------- ..............­.............. <br /> I hereby.celtify that I have prepared this application and that the work will be done in accordance with San Joaqtin County <br /> ordinances..State';ts, and rules and regulations of the San Joaquin.,Lqcal.Health District. <br /> (Signed).....,­ ........................ ................................................ ------ - --- ---(Own6r-and/or Contractor) <br /> ........... V- i-------------------­ -- <br /> --------------- <br /> ---------------------- -- ............ ...... . . ... ..... ..... ......I----------------------------------- <br /> (Plot plan, sho`w"ing size ofjot, location of system relation to wells, buildings,.etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. -- ---------­- ....... DATE----- ...... <br /> Z� DATE..-•---------" X _�---A.................... <br /> P------------------------------------- <br /> REVIEWED .BY.- ................... -------- ............................................................... .. <br /> ---------------- <br /> BUILDING PERMIT ISSUED....... .................... DATE................--------- ............................. <br /> ---------------- ---------- ------------- •-------------------------------- - V <br /> Alterations and/or recommendations:.... ....................--- -------------------------------------------------------...................­..................................................... <br /> ..........................................................­__.............I--------- ...........­­­-------------------••--------------------------• ---•-----...-_-.-.------"----•••-•---•................. --------- <br /> ....................... ........................ ..............................-----------------------------------•--••••--• ............................................................... <br /> ................................................................................................................................. .......­­­---------------------------------------------------------------------- <br /> 1. <br /> ---- ----------- ---------------------------------------------------- ---------------------------------------------------------- <br /> .r2 5 ���------------.................. <br /> Date......._.. .......... <br /> ------------ <br /> .............................................. ............. ......... ...... <br /> FINAL INSPECTION BY:..--_-_---.- ------ ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.14owton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,-California <br />