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FOR OFFICE USE: ¢u F i f 3� �.�.�Re. ;' � ✓. <br />------------------- ------------- ------------------- r R L <br /> �_______ _______ APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> ----------------- --------------1-- (Complete in Duplicate) <br /> ----------------------------- Date Issued ...--------- 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 Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..............._.!___/__��1 IF e A � ' <br /> ---- <br /> Owner's Name �...( -- ys es-"17- ��.>j1 P. _.._... Phone_ 7 ��-•/ <br /> Address /�"Z-&- ---------------------(----•------ -----------.---------------------------------------------------------------- <br /> Contractor's Name .......5_ 19e.,-'�`--- f------ ........ r--------------------------- Phone' --- A / <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -�_..... Number of bedrooms I�Number of baths ___t___ Lot size .................... <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,dote--------------------) 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 200 feet.) <br /> xx�� <br /> Distance from nearest well-----------------Distance from foundation_..._._._._._..._..Material_______.____...-................................. <br /> No. of compartments----------------- Size--------------------------------Liquid depth--------------- _ _Ca act ........... <br /> po <br /> fid: Distance from near st well Distance from foundation_)4&_r Distance to nearest lot line-•-. <br /> �d Number of fines________ ._____,_._ _ _____Length of each line------ _Q!___��____.Width of trench______•2.5lS�!.............. <br /> {�®�' Type of filter material... Depth of filter material..._._f_g_ �___Total length_......._ .� -_----__------ j <br /> Seeps a Pit: Distance to nearest well_ k0-"._____Distance from foundation__.., __•_...Distance to nearest lot line.....__ <br /> Number of pits...__--------------Lining material--- ae-,l __--..Size: Diameter.__ _„ _"!__..:Depth...... _ __!_______.... <br /> Cesspool: Distance from nearest well_________________Distance from foundation-----------.........Lining material..................................... <br /> ❑ Size: Diameter-------------------- -----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_________________________________________ _______Distance from nearest building------------------------------............ <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)---------------- ............ <br /> -----•-------------•------------------•-------•---•--•--------•--••------••----••------ <br /> _ <br /> --------------•----------------•------. ----------•-•------•--•---------------•-------------------- -------------- ---••------.........--• ---------------------------------------------------..-.—---•---._ i <br /> ( . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinancesj_� <br /> t ws, and rules d regulations of the San Joaquin Local Health District. <br /> IR <br /> (Signed) .. .. t g �._/.� !!Com' ----- Contractor) <br /> OOF A <br /> - ___.- k <br /> Title---------------------------••-------------- <br /> '�"` (Plot plan, showing size of lot, location of,system in relation t ells, buildings, c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- --- --- ----- ------------------•-------•------------------------------ DATE---------es- ---------------- <br /> ----------------- <br /> REVIEWED <br /> --------------- <br /> BUILDING PERMIT ISSUED..::....�..' £:__._+_-�_'"----------------------'-- ----------------------------...-----..._._ DATE....------------•----------•----------.._...---------------- <br /> 3 REVIEWED BY- : --------- ---------- <br /> � : ._-------------------------------------- DATE----------------._..--------------------•-------------••---•- <br /> Alterations and/or recommendations:-----------•---- -----------------------'-----------------------------------._........- ----•........----....-•---•--•-------------------- ------------------ <br /> �c f. -- <br /> fI.`'. tI . -_-•_-_-_•_--.---_•-•__--•____________________________________ __ <br /> ` __..._._... j ....................... . I <br /> -----­-------------1. } [ I <br /> FINAL INSPECTION BY:-- � --- -------------- - ------k----- / Date----��".,_ _1;7_ . ..---------------------------_- <br /> SAN JOAQUIN LOCAL HEALTHH-biSTRICT <br /> 130 South American-Street'""1 300 West Oak Street 124 Sycamore Strut 205 West 9th Strut <br /> Stockton,California Lodi,California , Liman'—,California Tracy,California <br /> EB 9 REVISED 8-59 2M 5-31 ATLAS <br /> t, <br />