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FOft`OF,FICE USE:_ No. <br /> c <br /> � �. rte: <br /> --------•-'----- � Permit .... .....�.... <br /> I SANITATION PERMIT <br /> ------------------- APPLICATION F( . -._. <br /> ------------------------------------------- <br /> ;(Complete n Duplicate) Date issued <br /> This Permit'Ex fires 1 Year From Date Issued <br /> Applicationd. <br /> is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe <br /> This application is.made in compliance with County Ordinance No. 549. /`� ' 0�"Z�6S'� 3L' <br /> Go tic sT oC N c -•- _c 3" ................. <br /> rl ----------------- <br /> f1 Q ' <br /> JOB ADDRESS AND LOCATION Phone------------------------------- . <br /> Owner's Name_ •-------------------------------------- <br /> - --------- <br /> - ----- ------ <br /> ----- <br /> may} ��ys'`�CLrC/Q a � C _ w <br /> Address - -------- <br /> ------------ <br /> ---- u_..__.... <br /> - -- --- <br /> Phone-----...----•-•-----•.............. <br />' Contractor's Name----------- ----------------------------"----------•---••---------•-------"----••---•- <br /> Commercial Trailer Court ❑ Motel ❑ Other`0 <br /> Installation will serve: Residence E?-Apartment !-louse ❑ ❑ <br /> - �-7-7--�--•-------�----=•----- • - . . ._ <br /> Number of living units: .---- Number of bedrooms __ Number of baths Y- <br /> Lot size <br /> ' Water Supply: Public system ❑ Community system ❑ Private Depth TO Water Table <br /> ft. <br /> Send Gravel ❑ San y Loam ❑ Clay Loam Clay ❑ Adobe Hardpan ❑ <br /> 1 Character of soil to a depth of 3 feet: ❑ �� No: <br /> Previous Application Made: (if yes,date....................1 No New Construction: Yes ]� '�o ❑ FHA/VA-."Yes Yes ❑ �❑ <br /> 1 TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> P---.---Materia ------ ----- - <br /> Septic nk: Distance from nearest well_.-Ca--•-Distance rom fa ndati n___ --- <br /> � p roe <br /> i uid de th---------- -- ---------Capacity/r <br /> No. of compartments--------- Z--------- <br /> - X+r q P " <br /> 4rC?_----. Distance to nearest lot ling <br /> Disposal laid: Distance from nearest well--r-50---_._Distance from foundation_.__ -• J- -----"----- <br /> --Length of each line`-<n----`� Width of trench__.___ -- .----•---••• <br /> ------ ------ <br /> P g J 1 l�-�� O <br /> ber of lines____.___ ---- fo ndation-------- --------Distance to nearest lot lm _.__-_.--------- <br /> Distance <br /> ` r, <br /> ___Total ken th___- _- _ �::.__:._,_.._ <br /> Type of filter material._��' �„�--.De th of filter material__.__ _.cP _� � <br /> g ---- <br /> 5eepage it: Distance to nearest well___ .Q_�_-___Dcstance from d/ <br /> Number of pits---------7 Lining material.--- <br /> " rze: Diameter­-13 <br /> Depth---- <br /> . � <br /> Cesspook: Distance from nearest w I <br /> Distance from foundation-------------------. ning Caterial-------------------------.----------- <br /> Cesspool' <br /> _.-.---- <br /> Li uid Ca aci gals. <br /> ❑ -------- q P tY-------•---------•------ <br /> Size: Diameter---------------------------- Depth <br /> Privy: Distance from nearest well__-______".._-- <br /> ------------------Distance from neares t building--------------------•------ <br /> ❑ Distance to nearest lot line--_____._-_______--_______________ <br /> -------------------------- <br /> 0 <br /> -----3---- <br /> �. <br /> X. <br /> Remodeling and/or repairing (describe}:--____-- --•,. --------------- <br /> a�c..�-g:�- ----------- ---------•--------•-------------- ------------------------•------------------•------------ <br /> I •-----•--..- --- - ----- -- •q-------•--------••------------ -- <br /> --------- --------•---------------- -----•--- <br /> 4. - --------------------------------••--------------------------..------------------------------------------ ------------------------------------------------------ ------------------------------ ------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State ws, ancf r es and regula 'ons of the San Joaquin Local Health District. <br /> k <br /> (Signed)---- - ---- ------- - •- -- --•----------- <br /> - ---------------- -------- ---------- ------- <br /> ---------------------------------------------{Owner and/or Contractor( <br /> Title ---------------------- ---- - -------- <br /> (Plot pian, showing size of lot, location of system in relation to weds, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE-----1-"1? •/7 ----- ~-- <br /> APPLICATION ACCEPTED BY--------------------------- - <br /> t <br /> IREVIEWED BY------------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------- •------------------------------------------- -...... ----------- ; <br /> Alterations and/or recommendations:______._.:==- _�= '`= { <br /> c`J -`-- -------------- •------------- <br /> r •-------• ---- <br /> -- . ---- ----------------------------- Date <br /> �14 <br /> FINAL INSPECTION BY:._--_-•- .----- <br /> � - -----------; ---— <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> 300 West Oak Srreet 124 Sycamore Street 205 west 9th street <br /> Stockton,California <br /> Lodi,California . ": Manteca,California Tracy,California <br /> E5 9 REVISED 8-59 2M 5-62 ATLAS <br />