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F FOR OFFICE USE: <br /> ----- --------------------------- ----------------------- <br /> APPLICATION FC)R SANITATION PERMIT Permit No. <br /> (Complete in Duplicate <br /> Date Issued .� .......�li�`_ <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constr�ta11 the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. �� ; Del <br /> 7 <br /> ADbRESS AND LOCATION- _ �- -..- &----- ! ------------- <br /> Owner's Name__________ _____ ___________ - Phone.-:------.-..-....._._-_ <br /> Address A� •--••-...06..ie...... .---•-•--•-•- <br /> ---- _ . <br /> ContractorsName--- - -- - - - --•---------------------------•--------•-------._._....---•-•-"---•-----------------------...__........... Phone.......................... <br /> Installation.will serve: Residence [1)'.,'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [IOther [3Number of living units: _ ._`_ Number of bedrooms 3___. Number of baths . ___ Lot size -_.._4. __ _. <br /> Water Supply: •Public system ❑ Community system ❑ Private Depth to Water Tabled,910__ ft. � <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® -Clay Loam ❑ Clay ❑—Adobe❑ Hardpan ❑i .Q <br /> Previous Application Made: (If yes,date------------_-------- No ;] New Construction: YesR No ❑ FHA/VA: Yes ❑ No ❑ �r <br /> TYPE OF.INSTALLATION AND SPECIFICATIONS: �- - <br /> ` [No septic tank or cesspool permitted if public sewer is available within 200 fee+.)'""`�"�`"' <br /> Septic Tank: Distance from nearest "-. Distance from foundation__40...........Material__ ......................... <br /> f No. of compartments _____.____•_-•..__-Size_ <br /> P �-'_ --4't,-I-LC....Liquid depth----�-----------------Capacity_4-7-----ll" ....... <br /> Disposal Field: Distance-from nearest welL"_a_:___Distance from foundation---fr �� <br /> ___`_______.Distance to nearest lot line__ __ _______ <br /> Number of lines______e�____ _._{___ .______. Length of each 1�ine:•�FQ__________________ Width of french. ........... <br /> ! T Type of filter ma <br /> Seepage <br /> . Depth of filter material__-./.r.._______Total length____•_-_ p_f_".-_________ <br /> - - --------- <br /> Seepage Pit:. Distance to nearest we ____________________l-Distance from foundation............-.......Distance to nearest lot line___.------------- <br /> ❑ Number of pits----------------------Lining material-------T------------Size: Diameter------------------------Depth------------------------.-------- <br /> Cesspool: Distance from nearest well_______--__'..__Distance from foundation....................Lining material........___..-_.......... <br /> ............ <br /> p Size: Diameter----------- ---;�-Depth-------�-------------------•-----------------------Liquid Capacity-...._..__.._...__.._....._.gals. <br /> Priv Distance from nearest well---------------------- .-----------Distance from nearest building ti <br /> Distanceto nearest lot line---------------------------------------- .=-------------...----•----------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)____________________________ "----' i_1.................... <br /> C - --- <br /> ---------------------------------------------------------------......................._--------------�--•-.._------'-------•--...............---------------------------------------------------""------ <br /> ---------------- <br /> � <br /> I = Ilk <br /> -------------------------------------------------.--••-----'---------- ----------•--•---•------•-•-•------------•---------------•---------•---------------------•-•-----------•-•---------------•-------•-••---------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinaia,. s6o�vi <br /> tate la a res d regulations of the San Joaquin Local Health District. <br /> t <br /> (Signed)-- <br /> ---------------- <br /> ► reed _____________________Owner and/or Contractor <br /> Y - .. - <br /> _ _(Title')_. <br /> (P64-1 ng sizeof lot, location of y t m in relation t'^o w Is buildings; et can b placed on reverse sideJ. -tea <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- --------------------------------- DATE_.__.. -------""-"-- <br /> ------------- <br /> REVIEWEDBY----------­ -•----------------------------- ••--------------------------- DATE-------•---•-----------••---------------------------------- <br /> eBUILDING PERMIT ISSUED.....-•--•---••-•----------------------------------------------------------------------------------- DATE.------------------- <br /> Alterations and/or recommendations-------------------------------------------------------------- .......................................................................-•----------------. ---- <br /> 1. . . .. .. ---------------------------------•-•-------------••-- <br /> ---•-•----•----------- ----- <br /> z ----------------------------------------------------------------------------------------------------- <br /> 9 FINAL-'INSPECTION BY:._- .- __-- Date-------- -^/ -63 <br /> ............ <br /> t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> s <br /> X6 9 REVISEO 8-59 ZM 5-61,ATLAS <br />