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t-UKUrrIC, U5 . it <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..:j'......... <br /> ---- <br /> -----------­­ f --�------- (Complete in Duplicate) (�'/f/ (� <br /> This Permit Expires 11 Year From Date Issued Date Issued ....................... <br /> Application is hereby made to the San Joaquin Local Healfh 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 <br /> '`LOCATION :----< �I f____�----(4.f7�0V:_.__.��`_�p Ail)- !------- <br /> Owner's Name.- F---`•-------- ` � -----------AM Phone.) - 3 98 <br /> Address. - -------.....3....3... --- --- e E�e/JS---- ------------ -•-----•------•-•--------•--•---•------••---------•-- <br /> F - ---- <br /> Contractor's Name .....f... �"/ 11 ".. �rh ------------------------------------- --- Phone. .. 4 <br /> 7. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ .l�Number of bedrooms .�. Number of baths// Lot size .._+�d_____�_-,�,,i�.......................... <br /> Water Supply: Public system ;Community system J—] Private E] Depth to Water Table/S�ft. <br /> � � l <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay [3 Adobe RY"k n EJ <br /> r <br /> Previous Application Made: (if yes;date------___--._._._--) No ❑ New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: a <br /> (No septic tank or cesspool permitted i ubGc sewer is available within 200 feet.) <br /> , �✓ <br /> Septic T ' Distance from nearest well _ __ ___Distance frofn'foun a4ion_./Q._______.Ma r' l.'6�,r�_____._ _ .-• I <br /> No. of compartments . Size_SS .: ___.Liquid depth-.-�- --------Capau <br /> I <br /> Disposal Id: Distance from nearest we4�'.Distance from foundation-../!e.........Distance to nearest lot line............ <br /> Number of lines___...c ___ ._Length of each line/tQ2'___,Iv t2__`..Width of trench____.,_ _.f.................. <br /> � <br /> -- - -- ----- <br /> Type of filter rnaterial__J f_ ___ CkDepth of filter material_. _"-------Total length.---------------------/-1611Q-------- <br /> Seepage Pit: Distance to neaII rest well______________________Distance from foundation....................Distance to nearest lot line--_-------_--•__- <br /> ❑ Number of pits-t--------------------Lining material-------'-------------------Size: Diameter----.-------.-.--..._.,Depth------------------.-__ <br /> Cesspool: Distance from (nearest wall-----------------Distance from foundation----_._--___-.__-.Lining material--------............ <br /> ......._.___..___ <br /> ❑ Size: Diameter-; ----------------------------------Depth------------------------------------------ -------Liquid Capacity-----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______________._-_---__-.-.__._-_.__-___. <br /> ❑ �I <br /> .' Distance to nearest lot line-----=-----•-•-••--•-------------------------- ------•-•-----...-----...-----+-------••-------------------•---•---••---....-------------------- � <br /> Remodeling and/or repairing fdescribe ------.- 4.�r" ,�--•- g I l_._. ��I <br /> a ------LLQlrl ,4,, ...1.5` <br /> ��-ky � -------------------I------- <br /> ------------------------------------------------------- <br /> -•--- = s <br /> I hereby ertify that I have prep ed Ais'.applicefion and that the work will be done in accordance with San Joaquin County <br /> ordinances, f laws, and rules a' egulations the San oaquin cal Health District. <br /> �. 1 �; <br /> (Signed)-•-- Ly. ------- -- - -- -- -- ---- --- ----- ---------- ------ ------------- •....... (O or and/or Contractor] <br /> 13y:......... :. - ------------------- ------'---{rifle)•--•--- --`---.....•......... ---------- <br /> (Plot plan, showing size of lot. location of syste in relation to welis,'b ' ings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ` �s------------------------------------------------------------------- DATE-- ---------------------------------------- <br /> REVIEREVIEWED <br /> WED BY--------•---------------- -- -------------------....... DATE.------------------------------ <br /> BUILDING PERMIT ISSUED... "----------•-•---- • ---------------------------- DATE. <br /> Alterations and/or recommendations:_1p-LQ.t-_�p_nZ,----- .____ -------I_yLS - 7 'i"sc�__..__1�L;N•-crs---------------------- <br /> 'l7,011�� <br /> . r.�.. d:.�.},.. ..-_ -�r�o.r. = � r��4 1'► _ t;.�. >,.'------..--_----.._. <br /> � ---- - ---- <br /> Q- - _.... .Q:-u.9. - ------------------------------------------•---• •----...._.- c_-_. $-. <br /> -�3 ..n_.e'T�fi.Q1Q� I `--�t – { �4-�_.....�-----.C_.e, � intt . ,t--;1 �;,_...._ <br /> �'�.s'�72 i� I+tJ A.� ti�►st'�c�•d. �1i4ei 1 h S 4 �fS\� t S.S�i+�, �-el C <br /> FINAL INSPECTION BY:------ <br /> 4,w - <br /> t <br /> x =. <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California ll Lodi,California Manteca,California Tracy,California <br /> P <br /> E8 9 REVISED 6-59 214 0-61 ATLAS <br />