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FOR OFFICE USE: . <br />------------------------------------- ------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...._.P r <br />--- ----------------------------------------------------- ..•........----.-- <br /> (Complete in Duplicate) f__-...�- G-3 I <br /> ----------------------- This Permit Expires 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 ein described. <br /> This,application-is-made-in ompliance with County Ordinance No. 549. 1 © , <br /> JOB ADDRESS AND LOCATIO]N- ---; i_L? ---- ------ 1I_ ©! _.... -'------- ---M1'�f---... v..... ----------1- Q1�--- <br /> Owner's Name------------ ------ ---- f ��---------------- -- Phone..--........ •---- <br /> Address...... <br /> MODS 5 ® <br /> Contractor's Name Q_S!lflu Phone--................................. <br /> Installation will serve: Residence Apartment-.House ❑ Commercial, ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .-)---- Number of bedrooms 3_- Number o baths-.,_ -ot size ---. --- <br /> Water Supply: Public system [ICommunity�system ❑ Private epth To Water Table F7 ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date---.___.....____--) No %r" New Construction: Yes [A-."No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available wit ) 200 feet.) <br /> 5ept'c nk: Distance from nearest well-- �___` stance`Tr m foundation____ _____._.M t ri l__�i C -----. <br /> No, of compartments-----,- --___-- Size .__-Liquid dept -- fir Capacity.... g;-1@4 .r <br /> Disposal Field- Distance from nearest well__SQ___IDistance Tf drmlfoundafion.-4/04K.Distance to nearest lot line..,.? <br /> Number of lines._..__._!- -------------- Length of each line- Width of trench----•�6-____.__ V} <br /> Type of filter material._.- 0_CXN_1Depth of filter material----.- __.....Total length-------------- --_-_---____--_-.- <br /> Seepage Pit: Distance to nearest well_-... .t-_7.77'Distance from foundation.............•_.....Distance to nearest lot line-------------.... <br /> ❑ Number of pits----------------t*:-,=Lining material-------------.---------Size: Diameter------------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well"�z.-_:;____ -Distance from foundation----- __-#_----.Lining materiak_________________._........._..___._ <br /> 1r #.-awr-- <br /> ❑ Size: Diameter-------------------------- ' " Depfh Liquid Capacity-----------------------_--gals. <br /> * <br /> Privy: Distance from nearest well -- _t------------------------.-----Distance from nearest building-----------___--_ <br /> ❑ Distance to nearest lot line------------------`: `- ----------------- •------- -----------------------------------------••-----•--•-------------------------------- <br /> Remodeling and/or repairing (describe) ', " .....- .... = ----. . <br /> r- _ �1�- .,__.. • k�" - -------- .i --------------------------------- <br /> _ N <br /> ------------------------------------------------------------------------------ <br /> -------------------- -----__-_ -__ _ .-----_____-__-__-----.._-_-__-_A'--_,_.___-_____-_-_----______, - ---------------------------------------I......--------­- ------------------------------------------- <br /> b I hereby certifythat that'l liave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San;Joaquin Local Health District. <br /> (Signed)---- - ------- ----^---- - --------------------------------•----•-••-----------------------------------------------(Owner and/or Contractor) <br /> By:.. -- -- ---------- ------- t (rt+le) <br /> ----------- <br /> (Plot plan, showing size of lot, location of sA#em in relation to yells,building`s,'efc-rehi 6e-placed on reverse side). <br /> A-- <br /> FOR. <br /> _FOIA.DEPARTMENT USE ONLY Qk Qk <br /> APPLICATION ACCEPTED BY•--~�__-,. ..... ---------------------- ------------------------------------------- DATE------/-- 7-- ''-���------- <br /> ------------ <br /> REVIEWEDBY------------•-•-------------------------------=------------------I------------ ----------------------------------------------- DATE------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE---------------------.----------------------------------- - <br /> Ahera+ions and/or recommendations--------------•------ — _, - —- _ . .�. t- <br /> --------------- <br /> ------------------------------------------ <br /> - _ -------•---•---------• ----- TED f ----- -`-- p� --------- ---• <br /> -- ------ ........._. -------------------------------------------------------- <br /> ------------------ ,f1/�-(._ _.__ ss ____...1!! _... il.�___._____._______ __-__ `_____. _r{_____._. ...__.___.....____.....____ _..__.._......_..____.____._____._._..____.___.... <br /> ---------------------F'Ar,4-13-.------T -- --"-- 1 3 "-= .. ..1-` --.. r4i— ---------------- ---------------------......------ <br /> , ,, t f* <br /> FINAL INSPECTION ------- ------ ---- --- Date-------- - -2 __42_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 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 2M 5-62 ATLAS <br />