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FOR OFFICE USE: <br /> ------------------- --------- -------------------- <br /> -- <br /> ------------------ <br /> -- APPLICATION-5,FOR SANITATION PERMIT Permit No. <br /> -------------------------------- -- <br /> (Complete in Duplicate) <br /> S! This�Permit Exeires I Year From Date Issued Date Issued <br /> 0 <br /> Application is hereby made-to the Joaquin Local Health District for a permit to construct and install the work herein described.' <br /> This application is made'inCompliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATJON <br /> ----------- ----- = ------=--------------------------------- <br /> Owner's-Name__----- ------- -------------------------------------------- Phon*e._?&__:7�1fjQ2-S <br /> ------------------------------------ ---- ........W <br /> ............. <br /> Address-................ 6011".1c...... ------------............................ <br /> I- ---------- <br /> Contractor's Name <br /> alanvff_�__. --- V -A---- - ----- - ------------------ _!------ Phone............................------- <br /> --------- ---- <br /> Installation will serve: Residence .-Xpartmenf House E] Comr-hercial E] Trailer Court [3-Motel [] Other 0 4 <br /> 1. . 1 -5 — <br /> -I. X <br /> Number of living'units:'__].�_ %;nber'�6',f be��Ir_o'o"ms___A�4-umber of baths Lot iizle r3V <br /> x r.7 <br /> Water SUNO�,Iy,: 1'f$iblic systomNE] Community system C1 Priv Depth To Water <br /> Character of soil to a depth of 3 fee+: Sand E) Gravel Sandy Loam E] Glayr Loam0 Clay Ej Adobe C] Hardpan 0 <br /> 'TIf'y­es,.date_,.;tk----- -------) Nod New <br /> Previous Applicition.,Made.% Construction' Yes [I No E] FHA/VA: Yes [I No [I <br /> : <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No ii6ipfic tank or cesspool peirmitted if public sewer isiavailable within 200 feet.) <br /> Se fiMa Distance from nearest well-----------------Distance from foundation___________________Material------- -------- .............. -------------- <br /> --No. of compartments-------------------- ----Size---I----------------------------_Li uid depth----------------------­--Capacity..................... <br /> Disp sa Fie& Distance from nearest �eil- IM-------Distance from foundation.....A� <br /> f ).. ...Distance to nearesteldflin.8--------------- <br /> Number-of linesJ............../ <br /> -----------a. enqf� of each line...........���_.Wiclfh of trench�-'�_ -- ------ ------------- <br /> Dept9 of filter material-:__l ---------Total length... <br /> Type of filter material .. ..... <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation--------------------Distance to nearest 11 ........... <br /> ❑ Number.of pits____________r___-__ Diameter____________-_-_..._.. <br /> Uning material..-------------__---Size: Depth__...._............. .:..... ....... <br /> 1 7 , N <br /> Cesspool: Distance from nearest Well-----------------Distance from foundation--------------------Lining material......................... ...... <br /> I i I <br /> E Size:, Diameter--------------------------------------Deptl----- -----------------------------------------------Liquid C aici ---------------- S. <br /> Privy: k Disf'nce from ne rest,well----------- <br /> a a ------------------------------Distance' `frorn nearest building------------------------------------------- <br /> Capacity <br /> I els ------ <br /> El Distance to near f �61 Ine--------/------------ -----------------------­ ....................----------------------------------------------------------- <br /> Ren)odeiing and/or repairing ------- <br /> ----------- <br /> 0, ------ <br /> - - - ------- -- <br /> ........ —--------------------- <br /> -- ------------------------------------- - <br /> ---------- <br /> -------- --- - <br /> ---------------------------------------- - ----------- ------------------------------------------------------------------------------------------------­------­--­­------------ <br /> herebyicertify that I have pre�iirpd pp and]that the work will be done in accordance with San Joaquin County <br /> ordin'ances. State laws, and rules and regul�fi6 ns of +he'San Joaquin Local Health District. <br /> A <br /> 9 ............ .............. n <br /> (Si .............. ----------------------------------------------------(owner and/or Contractor) <br /> --- ----------(----------------- <br /> ---------------------------------- --------------------------------------------------------------(rile)------- ---------............ T.—-------- <br /> a -f]- " -ion of �y_s+eW in relb6n' wells, buildings, Ce laced on reverse side). <br /> ings, etc., can p <br /> 110+1PI n, skowin4'sixe a at, locat <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ----------------- DATE- - - t:7� - --------- <br /> REVIEWEDDATE.-_.---- <br /> -- <br /> ---------- <br /> BY------------------------------------ I _A-------- -( I <br /> ----------- -------- ---- --------------------­--------­ DATE-------- -----------------------­------------ <br /> ------------ <br /> BUILbING PERMIT ISSUED------------- ------ -----------•---9 -------------------- DATE------------------------------------------------- ----------- <br /> Alter,ations and/or --------L-F-A-C-A-----105:rA--I,.ILA: ---------7;t;fi11--------- <br /> ---------------------------------------------------------- ---------- <br /> ----------------------------------------------------------------------------------------------------------------------------- <br /> -------------­----- ...... ----- <br /> ----------------------------------- ----------- ----- - ------------------------------------------------------------------- -------7-------1--R--.;.-.-0... <br /> -.-.-.-.- <br /> - - - A. ----------------------- --- ---------------- - --- ------------------------- - ------- <br /> - <br /> .. ........ ........ ..... - -- 1 t -_ --- ---- — <br /> FINAL INSPECTI --- ------------- ----- ---------------- <br /> ----------- <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 REVISEQ B-59 2M 5-62 ATLAS <br />