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n OROFFICE USE: Ike, <br /> T1-►._.may w <br /> APPLICATION FOR SANITATION PERMIT Permit No. ........ <br /> - ------ ---•------------------------------------------ (Complete in Duplicate) n xr S <br /> ---E--- This Permit Ex ires 1 Year From Date Issued 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_ .. -� ,lrtiC�s.^i��z�� .----- .---•----- ---------------------------------- -------------------------- <br /> Owner's Name <br /> Address...............__..-•---...__� . .- •--- .._lutis:�r.�..Q,---=� ----------------------------------------- - ------ <br /> . <br /> ----•---------------------•-------------...------........---------------••------------------•.- <br /> ......................-............... <br /> n <br /> Contractors Name__C _ sh-- .�.%_l t.:...........S�.,_c T_t S'es t................................. Phone-----H-V..-(0._ —P <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Frailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: __ .___ Number of bedrooms--3. _ ��....."� <br /> � �_ Number of baths .f.:7�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,date---------------_____l No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No2�__ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank. or cesspool permitted if public sewer is available within 200 feet.) <br /> SeC. <br /> pti Tank: Distance from nearest well.� �______Distance from foundation___!_Q._f._...Material....................... ............... ... <br /> No. of compartments- Size_ W ..Licluicl de h.__-ems _'f__ <br /> Disposal Field: Distance from nearest well-7X-_-_.._Distance from foundati n_ J _ Distance to nearest lot line..... _ <br /> Number of lines__,. __._______ Length of each line AVWidth of trench._.._c2_9(�!............. <br /> Type of filter materia Depth of filter mater, ^_'r '? Totak length____ Ct.. _________ <br /> --- <br /> Seepage Pit: Distance to nearest well______________________Distance from foundation <br /> ................. to nearest lot line................. <br /> ❑ Number of pits----------------------Lining material-----------------------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----------------_mw---_ -----------------------Distance from nearest building.__________----._--......_.____________._. <br /> ❑ Distance to nearest lot line.------------------------------------------• ......----•-•---......-------------------••-------•- <br /> Remodeling and/or repairing (describe):----------•------------•------------- ----------------------------------•---•------••-•--•-------.....----•-----------•------•----•-•---••---•---•---- <br /> ----------------­--------- <br /> ----------------------------- ....-----------------------•---------------••--•••....---------------•-•---•-------------------------•------- •--••--••---•----------------•--------------•------•------•--•----•I—— <br /> I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, to I ws, and rules and regulations of the San Joaquin Local Health District. <br /> Ili <br /> (Signed]-- ----.--- �_,�--- <br /> By: <br /> . ...... ------•-- -------------------- ---------------------- Contractor] <br /> By:---- [ <br /> -------------------•--------- ,6n.• - Title. ----------------------------------------- - -- -------------- <br /> (Plot plan, showing size of lot, location of system in relati to wells; build, gs, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ 1 --------------•---- ------ DATE..... ,` i' Via• ' <br /> REVIEWEDBY--------------------------------------------------------------•--•-------------------------------------------------------._.. DATE------------ <br /> ---------------- <br /> BUILDINGPERMIT ISSUED.-------------••------• --_--..............----------___.................------------------- DATE------------------------------------------•---------•------- <br /> Allterations and/or recommendations:------------------ ----------------------- ----- -------------------------------------------------------------------••--------------------- .. <br /> ------------------------•-•--•-•--------------- --•-------------------------------------------_-.. ----------------------------------------------------------------------------------...-------------------------•------ � <br /> / __-M------------------------11-----------------------------------------------W--------------M---------I-------------------- <br /> FINAL INSPECTION BY:---- -----•------------------------•---- : : I Date------1.1- (_S_.2-_b..ft_...... ---------------------- -•------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Stroot - -:.124 Sycamore street 205 Wort 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 RMSED 8-59 YM 5-61 ATLAS <br /> ti <br />