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FOR OFFICE USE: <br /> ---------------------- <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. -9.127-Z........ <br /> ---------------- <br /> (Complete in Duplicate) Date Issued <br />---- ---------------- -- ................ --------------- This Permit Expires 1,,Year From Date Issued <br /> Application is hereby made to the tan 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 L AT --------410/4007 0 00, <br /> t <br /> ...-00ir <br /> --------- -------- ----- <br /> Owner's Name_ -- --------- ---- -- ----- ---------------- i---- -------•----------- <br /> ----------1*------------- <br /> Address------X/2 4 --- ­­- ------- ---- ----- ----------------------------­---------------------------------------- <br /> Contractor's Name----C. -- ---------------- -- --- --- ----- ------------------ -----. -------- Phone... - <br /> ---- - - ------- <br /> Installation will serve: Residence Apartm t House Ej Commercial ❑ Trailer Court E] Motel [3 Other [I <br /> Number of living units:�----',Number of bedrooms I--_ Number of baths --- Lot size ...... 4-7wir--------------------------- <br /> Water Supply: Public system 0 Community system 06 Private El Depth TO Water Table -------- ft. <br /> Character of soil to a depth of 3 4et: Sand [-] Gravel E] Sandy Loam E] Clay Loam 5( Clay [] Adobe[j Hardpan C] <br /> Previous Application Made- (if yes,I date--------- -- -------I Nog New Construction: Yes [-] Nojo FHA/VA: Yes;q No C] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tanisfance from nearest well_ .Distance from foundatio,---10----------Material------A1.144W. 1--------------- <br /> e----- _X.1__!�_LZ,Liquid dep�h-----/2--------------Capacity---------------_----- <br /> 116' o. of compartments___-___-- ............Siz , <br /> Disposal Field: Distance from neare4stwel ---6.Distance from foundation Distance to nearest lot line-------(......... <br /> ------------- <br /> ❑ <br /> Number of lines ---- --------Length of each line------j�--------------------Width of trench.-----.______... <br /> Type of filter maferi -____-_-__Depth of filter material______________________Total <br /> ,--Total length-_____._ ---------- <br /> Seepage Pit: Distance to neairesf well----e ance f m unclation-----/. ........Distance to nearest lot ------- <br /> Number of pifs-------/-----------Lining maferial._ vm�--------Size: Diameter- Depth_.___. __ <br /> Cesspool: Distance from nearest well__7$P0P_A ._Distance from founclafion-_011-P95;�-Lining material___ 0------- <br /> El <br /> Size: Diameter_---- <br /> . --_Depth----------------------------------------- -------Liquid Capacity----------------_- --------gals. <br /> -------------------------- --- <br /> Privy: Distance from :nearest well------- -----------------4---------------- -- from nearest building-_-_________________-_-------_________-.. <br /> ❑ Distance <br /> uilding---------------------------------------- <br /> Distanceto nearest lot line----------------F------------------------------- ---------------------I----------------------------------I---------------------------------- <br /> Remodelingand/or repairing (describe)=-------- ------------------'------------------•------------------------------------------------------------------------------------------------------ <br /> --------------------------------------­----­- ---------------------------------------------------------------------------------­----------------------------------------------------------------------------------------- <br /> ------------I-------1-------------------------------------7-------------­----------------------------------------------------------------------------------------------------------­------------------------I- <br /> ---------- <br /> -------------------------------------------------------------I--------------------------I-----------------------------------------------------------------------------------------------­--------------------------- <br /> ---------- <br /> I hereby certify that I have prepared.this application and that the work will be done in accordance with San Joequin'County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---• --------- ------------------------------------ ----------I- -- --- -- ------------------ ----------------------------------(Owner and/or Contractor) <br /> (Titie)--------0_7U/7U,_o17 • -------- - ------ -------- <br /> - ------ -------------_--------- wo(.414t- ------ <br /> -ii <br /> I (Plo+ plan. showing, seize o lot, location of sys+/m in relation walls, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED $Y---- ------------- -—- ----------------------------------------- DATE--------- 7.------------------------- --- <br /> REWE <br /> VIED BY----------------------------------:°-----------------------------------------------------------------------**-------------------- DATE------------ ---------------------------------------------- <br /> BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------------­--------- DATE ---- ---------------------------------- <br /> T-_ ---------------------------------------------- <br /> Alterations and/or recommendations:-------4 ---------- _- ------------ ---------- <br /> -----------------------------------------------------------7------------------ ---------------------- <br /> ---------------------------------------------------------*--------------------------------------­­------------- - ---------------------------------------------------I------------------------------------------------------ <br /> ---------------------._._._._...---•-------------- ---------------------------- -----.:_------------------•-•---------------- ------------------------------------------------------------------------------------------- <br /> ---------------------------- <br /> FINAL INSPECTION ------------ Date.- --- --------�7. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICTV <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street;- 205 West 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,California TraCYr California <br /> ES 9;REVISED B-59 2M 5-62 ATLAS <br />