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x <br /> FOR OFFICE YSE: <br /> -- <br /> --- - --- ----- --------y- - ---------------- <br /> APPLICATION FOR SANITATION PERMIT Perm N a. <br /> -------------- ------ ------------- <br /> ---------------------------------- ----------------!------ (Complete in Duplicate) <br /> ------------------ <br /> Date issued ...... <br /> _ d <br /> ---------9--.1------ This Permit Expires 1 Year From Date Issue <br /> 4 - <br /> Application is'nereby made to the San'Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This a' plicafiori is made incompliance with County Ordinance k4o. 549. <br /> P <br /> -----------­.­--------- <br /> JOB ADDRESS AND LOCATION --- -------7 -9........ -------- -------------------------------------- <br /> I--------------------- Phone-.-II!------------------------------- <br /> Owner's Name------- <br /> Av, r& -------_-__._--•--_-------------•---- _ <br /> -­---------------------­-----------­---------------­........ <br /> Address------------- "_(/�........ -----------------------------------------------•---------------------------- --- ------------------ <br /> ------------ Phone--' ---------- ----------------_ <br /> Contractor's Name.......... 41TV;--------------------------- <br /> E] Other <br /> Installation willsei7e: Residence 50"*`Apartment House El Commercial E] Trailer Court El Motel <br /> ❑ <br /> S Z --------------------- <br /> Number of living units: J---- Number of bedrooms _A0 Number of bath Lot size --------- <br /> Water Supply: Public system El Community system El Private P-'-Dpfh to Water Table _i$V ft. <br /> 0. j <br /> Character of soil to a depth of 3 feet: . Sand El Gravel E] Sandy Loam El Clay Loam 0 Clay [:] Adohe i3l"Pardpan 0 <br /> Previous Application Made. (If yes,date__-.-_---_,__.___--] No Construction: Yes ❑ No 0-"FHA/A/ Yes [] No Z?' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> -------------------- <br /> S 1C Tank: Disfan'e from' 'nearest well----- -----------Distance from foundation--------------------Material - -- ---------- <br /> -------------- - - <br /> VIE , 9 - h. <br /> r-D-57-1 Alp No. of,compartments-------------------------Size_,..--------r-----------------Liquid deph-------------------- -- capacity---------------------- <br /> Disposal Field: Distance from nearest well___.I�_a-----Distance from foundation____le----- ----Distance to neare'st lot line--- -~-----• <br /> ------••-- <br /> Number of iines------ Length of each line---------e147----------Width of fro - ----------------- - <br /> ---4--------------- <br /> Type 'of filter materiaI__1j._X0,'64'_Depth of filter material--------le--------Total length_____.__,! ------------ <br /> '57 i�- . - - 9K, i III <br /> dl of <br /> 4V�6ge Pit: Disfance to nearest well------�6,P�------Distance frr foundation----IC---------Distance to nearest I ------ <br /> ts� <br /> i ------- --------------- <br /> Numbe'r of pi ---- ------------- Lining material___material---A;�O-k---Size: Diameter__ <br /> 04Cesspool: Distance from nearest:-w'e'll--- ------'.-'Distance from foundation----- -------------Lining ------------------­------------- <br /> 'Diameter Icity:11: ---------------------gals. <br /> Size: ----------!�Y---- ---F--Depfh----------------------------------------------------Liquid Cape ------- <br /> / It i -� � -1 �, / 'I <br /> Privy: Distance from newt well-". ' --------Distance7from nearest build ing-5t Il------------11-------------------- <br /> ------------------------------------- <br /> nea"est lot line__Distance to r ------------------------------ ------- -------------_7------------------------------------------------------------------- <br /> A -------11E' <br /> Remodeling and/or repairing (detri-be):--------------- <br /> -------------------------------------------- <br /> ----------------- <br /> ------------------------- <br /> --------­--------- -------- -------------- <br /> ---------------------­------------------------------------------------­­---------------------------------------- <br /> ----------------- <br /> --------------------------------------------7----------- - -----------------------------------------7---------------------------------- -------------- ----------------­ ----------- ------------------ <br /> iI^------i­-------------------------!�--------------------------------------------------------------------------------------------$----------------------------- <br /> -------------------------------------------------------- <br /> I - the" <br /> I hereby certify that 11 havd'�r`epar-ed this application and that work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and ru[Zs and regulations of the,San Joaquin Local Health District. <br /> , <br /> --------------- Contractor) <br /> ----- - ------- -------- -------------------- <br /> .(Title)---- ---------------- <br /> ------------------­­---------- <br /> (Signed)------ --------------------- <br /> By:-- <br /> L�- - - W Ax., <br /> ­ ------------------------ <br /> 6 d on reverse!'�idej. <br /> (Plot plan. showing s- %f lo' ocation ;f sys+ in relation to wells, buildings, etc., can be place <br /> Il <br /> g <br /> FOR D!SART OEY USE ONLY <br /> APPLICATION ACCEPTED 13'y........ ------------------- <br /> ------------------------ <br /> REVIEWED BY-------------------;---------------------- --------- ----------- ----------- <br /> ----------------------- DATE-------------------•- <br /> BUILDINGPERMIT ISSUED-------------------------- ----------------------------------i----• --------------- --------------­ DATE---------------------------11--------11-1--------------------- <br /> Alterations and/or recommendations:----------------------------------- ---------------------------------------------: -------------------------------------1-------------------------------- <br /> -------------------------- <br /> .......... ......... <br /> y - ------ <br /> ---------- --------------------------------------------------------------------------- <br /> ---------------- --------------------------­------------------------------------------------------------------- ---------------------------------- <br /> ----------------I-------------------------------------------------------------------- ----------- ---------------------------------------------- ------- ------------------ ------oi -1-- --------------------------- <br /> Ill.. ------------ <br /> ­---------------------------------- -------------------- ---------- --------------------------------------------------------------------------------------------------------------------------------------- <br /> - - --------------- <br /> FINAL INSPECTION B - ------ --- ---- ----------------- Date---- f> 0- ------- ------------------------- <br /> �SN JOAQUIN LOCAL HEALTH DISTRICT <br /> A JOAQUIN <br /> I 'j., I .- , - <br /> 130 South American Stre"ot 300 West Oak Street ',124 Syccirriore 205 West 9th Street <br /> k %- OV <br /> Stockton,California Lodi,California. j Manfo,ca,;.Californici T,a California <br /> EB-9 REVI6 EC 6-59 F,P:CM-2-6'60'` <br />