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EOR OFFICE USE: <br />-------------------------------------------------------- / <br /> No. <br /> Permit _..__ ..lb <br /> APPLICATION FOR SANITATION PERMIT / <br /> ------------- --------- ----------------------- (Complete in Duplicate) �1 _�6.3 <br /> This Permit Expires 1 Year From Date Issued Date Issued ._.._ _r....._ <br /> 0 per' l�---o <br /> Application is hereby made to the San Joaquin Local Health District,for a permit to co`nstrue and i stall the work h train described <br /> This application is made in compliance with County Ordinance No.549. e,-> <br /> 4 rc� -e— <br /> JOB ADDRESS AND LOCATION-___ .._v��..__-__ X___i � ----------------------------- <br /> ---------- ------ !!� <br /> Owner's Name... ! - --------------------------------=---•--=-- ----_ m-------------- <br /> ----------- <br /> _----.—_--_" _ Phone,-5 - Z <br /> Address �L. - --•-------��K--��-�------ i <br /> ` ..... ---------••-------•---••----•-•-----••. l <br /> Contractor's Name_________ _____ r'" ( Phone,�s 1:� -•---..•- 7. <br /> Installation will serve: Residence [ 'Apartment House ❑4 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .../__ Number of bedrooms ---2- Number of baths ----/.. Lot size _72 ....... •_'....................:.. <br /> Water Supply: Public system ❑ Community system ❑ Private R Depth To Water Table _bV ft. <br /> Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy,Loam [tj'�Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: llf yes,dote--------------------) No ff"' New Construction: Yes ❑ No 2 FHA/VA: Yes ❑ No 2r-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: k <br /> 9 <br /> .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank:} Distance from nearest well---�C? __Distance from1foulri-dation-_-_ p_ ___--.Material____ _ ---------- <br /> ro- <br /> ❑ J� No. of compartments-------- -----------Size------•-------••-- % ----:Liquid depth----------- -------------Capacity------------------•---• Irl <br /> Disposal Field: Distance from nearest well---hV_.0-- -Distance from foundation----- -__-Distance to nearest lot line____ ...`.... m <br /> ] `�1 r Length of each hne' .-------�-- - Width of trench---------•�.V_ -11 <br /> - <br /> Yj`� Number of lines....:...... ..r;�.� <br /> --•-----Total 'length---------------------- ------ <br /> Type of filter material_.1CF��.lam__.Depth of filter rriaterlal..__.-18 <br /> Seepage Pit Distance to nearest well__/f1�3_!___.Distance from foundation.__,/0e_' __.Distance to nearest lot line----S........ <br /> ® 1 1 Number of pits------ ----------- Lining �aterial__, , <_Size: Dia meter-__.- ��__.:Depth__..-.-.-.. -__`_..___._ i <br /> �ad1 <br /> Cesspool: Distance from nearest well_'"~-^"_' ":_Distance from foundation------------_-------Lining" material--------------...-------------------- -1 <br /> ❑ Size: Diameter--- i --------•-Depth------------------ ---------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well---------------------------------------------I---Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------------------------------------------ ------­-------------------- <br /> Remodeling and/or repairing (describe):----------C2lo-leW_- __•_.- ,� -- --- - p''• •- ----_-----_--••---•----_-• ' <br /> t i t <br /> _--------------------------------------------...........-------.___________-_____________-_____________-_----_-_-____-__ _________-_•___-________.___-.-.____--_-_______-____---_----________--.__-______________--_-____---_ <br /> .k»�' '. <br /> - -------------- ---------- <br /> hereby certify that I have prepared this,application andfha+ the work•will be-done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of Ab San Joaquin Local Health District. <br /> •, I t� � t � , <br /> �� ---- -------- = Owner and/or Contractor <br /> (Signed) c _ ------( ) <br /> - _ ...� :_ .... ....----------- - <br /> (Plot plan, showing size of lot, Iota+i�sysiemelation to wells, buildings, etc., can be placed on reverse side). <br /> ;'--FOR DEPARTMENT USE ONLY ( ; <br /> APPLICATION ACCEPTED ----------------------------------_----IDATE---- _-" .' -------- -------------------- <br /> REVIEWEDBY---------------------------------------- i 1----------------------------•---•------------------------(DATE--- ---------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------ __-- _ ----_---------- ----- DTE., - <br /> - - ----- --------------------------------------------- <br /> .. - <br /> Alterations and/or recommendations:__=____.__.€_________________ " - <br /> E t <br /> r I t <br /> 1 a ; <br /> � ' I { <br /> --•-----••-------------------•---- • --- - --------------------------•---------- ---:---------------------------•-----•----------------Date------ -. •------------- --------------------------------------------•---•--• <br /> FINAt WSPECTION BY:. �, !� ................... �� ^ 6� <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 />