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Z� ollf <br /> e D' ATION FOR SANITATION PERMIT Permit No - - _ '_�__-__- <br /> `� APPLIC <br /> 4V (Complete(Complete in Duplicate) �� l S-7 <br /> '�' Date issued --------------- • -- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein described. <br /> This application is made in compliance with C unty Ordlnance No. 549. 0, <br /> JOB ADDRESS AND LOCATION ' -------- - ------ <br /> Owner's Name----------------- --------- - -- -- ---------- <br /> -------------------------- Phone----- <br /> -- - --- -- --- -- <br /> Address-------- / -----= <br /> Contractor's Name------------------- ---• :----------------------------------------------------------------- Phone-_----------------------•---------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [jMotel E] Other [3 <br /> Number of living units: J__ Number of-bedrooms _ Number of baths _ ___rLot size -k-.� ---------- <br /> t Water Supply: Public system El Community system 2?'Trivate Depth to Water Table, <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes El No New Construction: Yes No E] 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 /> SepticTTaa Distance from nearest well Distance wjff om foundation----ap:_.=___.Material--- <br /> ------ <br /> Liquid deth__zNo..of compartments----- sie_ ___ <br /> Disposal Field: Distance from nearest well------- -.Distance from foundation_��________-Distance to nearest lot line-_.0 <br /> Number of <br /> b lines------ --------- ength of each line----- "-._.---- ---Width of trench----r _a ---------------- <br /> TYPe of filter material_ /- Depth of filter material------f�>�-___Total length______ ----------------- <br /> W <br /> Seepage •t: Distance to nearest Ce ------ _____ Distance from foundation__ _ .Distar `e to nearest lot line _ __. <br /> Ar Number of pi- _______Lining material__ -- 044 .Size: Diameter__. _________-Depth__ Z.ti�____,1�t�j1. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------. ----.Lining material-------------------------------------- , <br /> F1Size: Diameter--------------------------------------Depth--------------------- ------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> Distance <br /> -- ---------------_---------------------- <br /> Distanceto nearest lot lire----------------------------------- --------- -------------------- ----------------------------------------------------------------------- <br /> � <br /> Remodeling and repairing {describe}:------ '' --- <br /> - ---------•---------------------------------••----•------------------- <br /> --- -------------------------•--------------------------------------- ----- -------------------------- <br /> ----------------- -------------------------------------•----- •---•--- <br /> _______________.__-_____________--i______--____________________-___________.--_-_____________________________-________-________ <br /> 1 hereby-certify 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 a d regulations of the San Joaquin Local Health District. �. s <br /> (Signed) -------------- --------- A-4 <br /> `' - --------------(' r Contractor) <br /> By:.....------- ----------------------•--- --------------------------------------(Title) zolw <br /> (Plot plan, showing size of lot, location ystem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- - -- - -- ------------------------------------------------------------------- DATE-------- -`--- -----U------------ ----------------- <br /> --- --- <br /> REVIEWEDBY------------------------------------------------------------------ ---------------------------------------- x DATE <br /> BUILDINGPERMIT ISSUED------------------------------- ------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-------- --------------------------------------­­-------------------------------- ----------- --------------------•------------------------------------------ <br /> ? 7;;r7_757 '� �1v r R_ fp � � -------------------- ------------------------------------------------ <br /> t -P-T1-fs �� lr- D * Os?_( _- I-�Ny7' d� �'Z7" 9 <br /> ----��:tux. = a, �- ,. S.-_ - - ----------- � ° _mss- T, <br /> . . <br /> ---------------- -------------------------- -------------------------------------------------------------------- ----- <br /> FINAL INSPECTIO $Y:_ __ Date------- ___` `� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street -132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> 5 ES-9-2M•, Revises 1.57 fr.P.Co- <br />