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.................ip <br /> �� /�c% f r -ION PERMIT Permit No. <br /> L-----APPLICATION FOR SANITAT <br /> (Compissued <br /> lete in Duplicate) Date Issued ------- <br /> This Permit Ex Dires 1 year From Date construct and instj the work herein described. <br /> Joaquin Local Health District for a permit to <br /> is hereby made to the Sar <br /> Application compliance with County Ordinance No. <br /> 549. -------- <br /> This application is mad, in comp -------------------•-------------• <br /> ------------------------------------- <br /> JOB ADDRESS AND cATiON.___/-,0-/ ---'-'-----•-, ------------ Phone------------------------------------ <br /> ----------------------------------------------- ------------------------------ ------ <br /> ..... -- --------- --------------- ------------------------------ <br /> -------------------- <br /> Owner's Name— ---------------------*----- ------------- Phone----------------------------------- <br /> ---------- <br /> -—---- -------- ---- <br /> Address - ------------ ------------------------------------------------- <br /> ............ <br /> Other ❑ <br /> ------ ...... <br /> Contractors Name__- Trailer Court 0 Motel 0 <br /> Residence W"Apartment House [] Commercial 0 size ---- --------------------------------- <br /> installation will serve- Number of bedrooms Number of baths ---I--- Lot <br /> -1 stem [] P-riva <br /> Number of living units: te El Depth to Water Table dobe U�—Hardpan ❑ <br /> Water Supply: Public system [VI-Community SY Gravel 0 Sandy Loam Ej Clay Loam C1 C;ay ❑ A <br /> Character of soil to a depth of 3 feet. Sand 0 El No 0 FHA/VA: Yes [I No El <br /> Previous Application Made. yes 0 No <br /> New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic lank or cesspool permitted if public sewer is available within 200-_feet.)-----­­Maferial-------------------------------- <br /> ----------------- <br /> Distance from nearest well-----------------Distance from foundation -------- Capacity---------------------- <br /> ---- --- - <br /> Septic Tank". No. of compartments--------------------------Size--------------------------------Liquid depth------------D i stance--to--n-earest lot line----------------- <br /> 4�>� Distance from nearest weil------------------Distance from foundation---.-.------ -Width of trench------------------------------------- 0 <br /> Disposal Fie.10— --------------Length of each line-------------------- -Total length--------­�-------------------------------- <br /> Number of knes--------------------- Depth of filter material--------------------- ¢--- <br /> :� /__ c <br /> Type (5f filter material------------------------- e to nearest lot line.--- --- <br /> afion__3!�' Disfaric <br /> Nor -X. ice from found 41 Z,� ----------------- <br /> --- -----e-----Distar eptH-..- <br /> /.L,q <br /> Distance to nearest well-- ---Size: Diameter-----3_� - -Depth-.._,Seepage Number of pits-------------I--------Uning material-_-""- <br /> nearest well_____-"__-_------Distance from foundation=- <br /> oundation--------------------Lining materia�------------------------------------- <br /> Cesspook Distance from ---------- ----Depth----------------------------------------------------Liquid Capacity----------I------------------gals. <br /> Si❑ ze: Diameter--------------------- , t ­_:----•-- ------------------ <br /> I - f Distance from nearest buiiding------------ <br /> Distancefrom nearest we i�------------- ---------------------------------- ------------------------------------------------------------------ <br /> ------------------------ <br /> -- <br /> Privy-. Distance to nearest loft line--------------------------------------------- ------------------------ ------ <br /> 11 <br /> Remodeling and/or repairing (describe):--------- ------------------------------------------------------------------------_-----------------------------------------------------------------_--_-_---------------------------------------------- <br /> ------ <br /> -------------------------------------I---------------------------------------------------------------- ------------------------- ----------------------------------- <br /> -------------------------------- ----------7-------------------------­--- <br /> - ----------------------------------------:------------------------------------ ---------- --- ------------------------------------f_,::--------------------------- --------- <br /> -------------------------------- <br /> -------------------------------------- ----------------------------------------- --------------------- d that the work will be done in accordance with San Joaquin County <br /> I hereby certify tlria� I have prepared this applicati6n an Health District. <br /> sr and 3 certify <br /> and rules and re lations of the San Joaquin Local <br /> ior <br /> ordinances, State laws _ <br /> - --------- ------------------ ----------------------------r -__---(Owner and/or Contractor] <br /> (Signed)---------------- -------- ---------- - ------- --- --- -------------------------------------------------------------------------(Title]----------------------------------------- --- --------- ------- <br /> t <br /> By:-- 04 cation <br /> reverse side). <br /> 'on of <br /> , r <br /> (Pilot plan. �owi stem in relation to wells, buildings, etc., can be placed on r <br /> FOR DEPARTMENT USE ONLY <br /> ATE <br /> 47---- <br /> ------ -- -------- ..... C4-------------- <br /> APPLICATION <br /> 4-------------- <br /> APPLICATION ACCEPTED BY---- __n--- ------- <br /> REVIEWED BY--------------------------------------------------- -- ------------------------------------------- -------------------------- <br /> - DATE.__._. ...... -------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------—-------------------------------------- DATE - <br /> ---------------------- ------I---------------I---------------- <br /> Alterations and/or recommendations:--------------------- --------- -- -------------------------------------------------- <br /> ------------ __----- —----- C'.., <br /> ----- ----------------------------------------------------------------------------I------------------- <br /> ------------------------------------------I---------------­-------------- ----------------------- --------------------------- -----------------------------------I------------------------------------ <br /> ------------------------------ ---------------- <br /> ------------------------------------ ---- -------------------------------------------------- --- --------------- ---------------------- ------ ----------------------------------------------- <br /> - --------------- ----------- ----------- - ------ ------ ------- -------- --------- ------------------------ --------- <br /> Date--- --------1-f ------------------------------- <br /> FINAL INSPECTION <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street Tracy, California <br /> Stockton, California Lodi, California Manteca, California <br /> Revised 0-'59 F.P Co. <br />