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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> _________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. _.,--__-_--_�o___-----� <br /> {Complete in Duplicate) 1 <br /> ------------------------------------------- ------------- Date issued ------ ---. . <br /> __--____.___ This Permit Expires 1 Year From Date Issued ..-__ -.b -3 ` <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constru t and install the wor herein described <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS LOCATION `^-'_-----"-'T--a?I7A--r- - ----------------- <br /> Owner's Name— <br /> ------------{�4�;;���Sc�M� ----------- -------------- Pone <br /> Address ----- 40 <br /> � i_ t�.LJ- I <br /> Contractor's Name__._._.___ ./------------------------ <br /> --- ------------------------------------------- Phone---•------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: /____ Number of bedrooms __/__ Number of baths __/_ Lot size --- _________________.._.___..____-___________._____ <br /> Water Supply: Public system ❑ Community system -❑ Privatey Depth to Water TableyQ_ 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,date------------_------_) No ❑ New Construction: Yesg 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.) 49 <br /> Septic Tank: Distance from nearest _Distance from foundation <br /> --- lJ_'__.Mater�l__ <br /> ----------------------- <br /> ------------ <br /> V No, of compartments______p9_________--_Size._r�__ ,2�_ ___._._Liquid depth_ ________________Capacity. ------------------- <br /> 01-- <br /> U __ __- <br /> Disposal Field: Distance from nearest well._.Jr_�_0____._Distance from foundation__t?_d________.Distance to nearest lot <br /> Number of lines-------/--- ----/ j- Denghhofffil#er�mlateria _r--. Total length nch-----,�-YSD ------ <br /> Type of filter materiaL_61t_/��`�c- p <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.----------.Distance to nearest loft line----------------- <br /> 0 Number of pits----------------------Lining material-.---t-- ------------Size: Diameter-----------------------Depth--------------------------- -- _ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------------- <br /> Size: Diameter----------------------------------- --De th--------------- ------------------------------------Liquid Capacity-- -------------------------gaffs. <br /> Privy: Distance from nearest well ______-________________________-----------------Distance from nearest building------------------------------------------ � <br /> ❑ Distance to nearest lot line---------------------------- <br /> € <br /> -- -------------- -----------------•----------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)------ ' ' ------191L ----------------------- '•----------~. <br /> ---•------------------------------------------------------------------•------------------------------------------- ----------- - <br /> T+ <br /> ----------------------------------------------------- =----------------------- <br /> ----------------------------------------=---------------------------------------- <br /> Ito <br /> ------------------------< ------------------- -----------------------------------------------•----- ----------- -- ---- '+'P <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, to laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--- ------------------- - -- - --- Owner and/or Contractor) <br /> Y• (Title)---- "'� 't --- ------------ <br /> -------- ---------- ----- <br /> (Plot plan, showing size of lot, location of system in relation to well , ulldfngs, etc., can be placed on reverse side). O <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----! /r'17 c,% ----------------------------------------------------- DATE-----f� <br /> REVIEWEDBY-- : -y-----•------------------------------------------------­_---------------------------------------------- DATE------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------ ------- <br /> Alterations and/or recommendations-----------------------•------------- --------.--------------------------•----------------------------------------- <br /> --------------------------------•----------------------•---=-------=------------------------------------------- ------------------------- ------------••-----------------------------•------------------------ --------- <br /> -------------- -----•--------- ------------------------------------------ - - - -- ---------------------------•-------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:---//-`- - --- <br /> w- SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 r.p.100. <br /> } <br /> =1 - <br />