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OFFICE USE:, 0( A-- <br /> A <br /> --------------------------- ------------i <br /> ----------------------------------I. APPLIcATibN FOR SANITATION PERMIT Permit No. <br /> ------------------------- ------------------------------11, (Complete in Duplicafel <br /> Date Issuedle.................. <br /> --------- ------------------------------ This Permit Expires I Year From Date 15566-d. ..;..,Date <br /> Application is hereby made f9 the San 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 LOCA, ON ........... ------- -- ---------- r <br /> - t116a%..2.�..y*......... ............................................... <br /> j 'S­�a 4-L <br /> '_- - <br /> Name----------............. ........... ------------ ........ ------------------------------------......----­---------------- Phone_' <br /> Address.................................. 4 r <br /> ..............................................I............------- ....... <br /> Contractor's Name............... <br /> --------------I-----------------------------------------L.............. Phone-40 300 <br /> Installation will serve: ResiclAte Apartment House E] Commercial ❑ Trailer Court [] Motel 0 Other L] <br /> Number of living'u n i ts:11 /... Number of bedrooms Number of baths _ _,!Lot size ................. <br /> Water Supply: Public sys.tem,El Community system 0 PrivateJ4 Depth to Water Table -------- ft. <br /> Character of soil to a depth d 3 feet- Sand (-] Gravel [] Sandy Loam'' Clay Loam 0 Clay 0 Adobe[] Hardpan 0 <br /> '"1111 livI. <br /> Previous Application Made: llf Yes,date_.__..__-.-__._.___) No [] Now Construction: Yes ❑ No ❑ FHA/VA: Yes 0 No [j <br /> yl <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic'Tank: Distance t6m, nearest well..-,570-----Distance from found ion____._I-q-------Material..5,-C��Ov'�� <br /> ................. <br /> No. of from V ��6 X., <br /> .Size....V-11,X.6,t%-51.....Liquid clepth------- 5_�.-S.....Ca pacit"Y__.�'....... <br /> • <br /> Pisposal Field: --D;stance -f-L nearest�welL__67_0---- Distance from foundation....&.1-----Distance to nearest lot line...... <br /> Number of lines_______,,_______a---------- ----Length of each line--,2-Y_1 <br /> -- Width of+encli--------2.�--- <br /> - ­` 7---------------- <br /> Type of filter mafeirlia"I---:,A 4,e—-----Deptho' f filter mafc�rial-------ZY-'I <br /> ----------Total length------- --------------------- <br /> Seepage Pit Distance t V nearest well_-,'_/6_a/----Distance Aforn foundation------�12--------Distppce to nearest lot line",' ....... <br /> Number of-pits---------a- ----Lining material...KO-C. _._._Size: Diameter----VA"')'.,01'fDepth-------- <br /> Cesspool: i Distance from nearest well-----------------Distan-ce frori`fo' uni'dation--------------------Lining material----------_----..................... <br /> El,, 41Size: Diaroeter--------------------------------------Depth----------------------------:----------------------Liquid Capacity----------------------------gals. <br /> J ; <br /> Privy: Distance from nearest well____________________--------------------------Distance from nearest building--------•-••..............:.........il: <br /> 0 Distance fb nearest lot line----=-----------------•------- --------- ---------------------- <br /> Remodeling and/or re -p ai ri n (clescriilb, o---Zu, <br /> --- --- -----....... ...------- <br /> - - ---------------- -- . ....... <br /> ----- ----------- ------- --------------------- -------------------------------•----•------- ------------------------------ <br /> ----------------------------------------- ._.......•----------- <br /> 1 hereby <br /> .............-------11hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, d ru <br /> q1 i <br /> and re tion e n Joaquitntocal Health District. <br /> (Signed).-. it . ... --- ---- ---------------------- -------`L--------------------------------------(Owner and/0�r Contractor] <br /> 1, <br /> BY:----- --- ----------------------------------------------------............ �.__'(Title)----..L___ I.- I <br /> ------------------------- ------------L-------L.................................. <br /> (Plot plan, showing size of lotjocation of system in relation to wells, buildings, etc., can b8 placed on reverse side). <br /> I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED Be-- -K.-:---------------------------------- DAT9------ lr..-,;_,----------- <br /> REVIEWEDBY--------------------_-•----------------------- - ---- ----- ----------------- ----------------------------------- DATE---------- <br /> BUILDING PERMIT ISSUED_A(I--------------------------------- <br /> --------- ------------------------------------ DATE_—)----------------- <br /> Alterations and/or recommendations:----9=7._ ----------7' ------I-Ir- <br /> ------ .....­........ <br /> ---- ................ <br /> -­­--------�C-------­---------- --------------------------- <br /> -------- --- AX ---------------- ------ -�c------------------------------------------- -------------------- <br /> / <br /> .. ....0 -b-------------------L-------------------------------------------------------------- - ----------------------------------------------L--------------------------- <br /> !j; <br /> ............. ---------------------- ­------------------------- ---------------------------------------- --------------------------------------- ---------------------L-L--------------------------- <br /> FINAL INSPECTION BY-----=------- -------- ---------------- ------------------­ Date-----------------------------------------• -- <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 /> rG 9 REVISED 6-59 ?M 5.951 ATLAS <br />