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FOR OFFICE USE: <br /> -------------------------- <br /> ---------------- 7� <br /> APPLICATION FOR SANITATION PERMIT errl'lit No. -.-_I....---.-----._-- <br /> ------------ ---- <br /> = t. (Complete in Duplicate) _ , .. <br /> . Date Issued <br /> _-_-.---____.__ This Permit Expires 1 Year From Date Issued <br /> -- ----------------- = <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 ingompliance ith County Ordinance No. 549. Zl, Z - t?O•-12- <br /> JOB ADDRESS AND LOCATION=_ __ <br /> �¢c� _ one <br /> Owners Name-- -------- - <br /> . --------- / - ------------ �� <br /> P <br /> Address------------------------ ----- =... -Wit- -------- ------------------------------------ <br /> Contrastor's Nama___-- ' ---- P onr e---------- -------- <br /> -----. <br /> ---- <br /> ------------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial .0 Trailer Court �❑ 'Motel ❑ Other ❑ <br /> tsx 7 3 <br /> Number of living units:..__.___ Number of bedrooms T__- Number of baths j___._ Lot.size _____ -.----------------------- <br /> Water Supply: Public system El Community system ❑ Private Depth to Wafer Table P'-__ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ CIay4Loam ❑ Clay ❑ Adobe 2f—Kardpan ❑ <br /> Previous Application Made: t(If yes,date.__.------------- -) No t-_-New Construction: 'Yes �o ❑ FHA/VA: Yes ❑ Not <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: P ~` <br /> No septic tank or cesspool permitted if public ewer is available within`200 feet <br /> r *- �? ----------------------- <br /> Septic Distance from nearest well_.__. ---_ -Distance from foundation__ _d_: _ Materiai _ � <br /> No. of compartments--- - :Size E cl P.' P Y & o <br /> Y 't Liquid de th- -- -------Ca Capacity <br /> - _Distance from <br /> �a -_------ DiS ace to nearest lot line---,. <br /> Disposal Field: Distance from nearest well. --------Distance from foundatiot3_ `i�N 2� �� <br /> Number of lines_---____ g t . // <br /> k *3 L.en th of each line - _s. th of trench_.. <br /> Type of filter material�Ilk_C/ ________Depth of filter material_,! ".______}.__._Total length_______.__1<0_�_ _---------_---------- <br /> -r <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------.Distance to nearest lot line------------------ <br /> 17 <br /> ❑ Number of pits----------------------Lining material----_------------------------- --- <br /> Size: Diameter._._---:------.--------.Depth------------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-______---_.____--.Lining material____--_-.____.__________:_____. __. <br />� <br /> a <br /> Size: Diameter---------------,;.�..;;-----..�: Depth , t.�--- -- --- � i --,�-�gal -�.. <br /> Lsqu d cap <br /> _ __. .� � <br /> -,city <br /> � <br /> Privy: Distance from nearest wel----------------- --------------------------------Distance .from nearest.building ------------------------.__.__ - <br /> ❑ Distance to nearest lot line-------------------------------------------- ------------------_------- s-------------------------------------- ---- <br /> 1 1, <br /> Remodeling and/or repairing (describe):____________________i/ _ - ---- <br /> - z-4 - e_ ----- /---- ----t. <br /> fut <br /> _______- <br /> ' - - -----------------•----------- <br /> ----- ------ --------- ----------------"---------------•-----------------•-----------------------------------------------=--------------------------------•------------------------- ------ <br /> ! hereby certify that I have prepared thi ppf ion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regul i ns +ht3 San Joaquin Local Health District, t <br /> r t <br /> (Signed)_ ( ' (Owner and/or Con+racto <br /> t <br /> BY: - -- -------------- <br /> ------ -- ------- ------------------- -----------------------(Title)---------- ----------------------------------- s <br /> I,. <br /> (Plot plan.-showing-size`of lot, .s stem.in='rel ion to-wells;buildings,-etc.; canmbe-placed-on-reverse side). <br /> FOR DEPARTMENT USE ONL <br /> C77 <br /> �� DATE _ <br /> APPLICATION ACCEPTED BY------------------------------------------- <br /> ---- - <br /> REVIEWED BY------------------------------- --------------------------------- ------------------------------------ -------------------- DATE---------------------- =---------------------------------------------------- <br /> - <br /> PERMIT ISSUED----- --- -- : ' DATE <br /> Alterations and/or recommendations:------ ------- -- ------- --------------------------------•----•- <br /> s„r t ----------------- <br /> -------------- <br /> E <br /> --------------­--------------------------- -------- ------------------ <br /> i <br /> ------ ------ <br /> FINALINSPECTION BY:---------- ------=------ Date---------- --------...�-....------------------------------ ------------- <br /> 1 ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton 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 1.7.59 3M 3-163 F.P.0 C. ., y <br /> yJyl <br />