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FOR OFFICE USE: <br /> -------------=z------------------------ ------------- - <br /> ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. _1l .rz <br /> Ii, <br />--------------------------------------- --------------- (Complete in Duplicate) 9 <br /> This Permit Expires I Year From Date Issued Date Issued .__..._..___I ------- <br /> Application is hereby made to 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. �5-,o q o—4� <br /> .j.1 d -S . r',,ys<..@-c.6-ra- Z9&1_0' :. <br /> Jb6 ADDRESS AND LOCATION._..HLflf',_ -v._.__, �1,ST_ F___.Q_�' �P,f,�s'S_,rY..- Zr�f•P•�� <br /> Owner's Name------ '-----Z1"?01Ae_jj-74?_A.. <br /> ----------------- Phone-7` <br /> Address /'Q ­e­...,0'r'�...... <br /> . > •. }.�1.�'�= -----•--•-------------•--------••------------ <br /> �'�.. . ....... Phone. fa. 0 I` <br /> Contractor's Name................. • ......................................... . <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial e Trailer Court ❑ Motel ❑ Other ❑ P:Z <br /> Number of living units:..........Number of bedrooms -------- Number of'b lths _7--_ Lot size -------a5..4e.de. .................. <br /> Water SupPI • Publics stem ❑ CommunitY system ❑ Private FT--Depth to Water Table ________ ft. <br /> - <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________! Nc-2y New Construction: Yes E No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPEC FICATIONS:�'�""'�- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feef.),_ �, �,,,•„� <br /> t F - <br /> Septic ank: Distance from nearest well----0Q------Distance from foundation..'XZ...........Material.___ !_ .._..._ %�l�a.... <br /> r1 <br /> No. of compartments----------It--- 56----------size_.__._.__..: _/f_.._._____..Liquid depth-----__ _______-- _--!Capacitye. _.&.-V.! <br /> Disposal Field: Distance from nearest well__-Q`_.._Distance from foundation...4 C?.......Distance to nearest lot <br /> Number of lines.....- <br /> ines.....}_______________________Length of each line---,!�'---t._X_V...Width of trench------A.�`:...._...... <br /> Type of filter material..._;_Z?0 _k_____Depth of filter ma#erial_R__/_d''�------Total length.`_._.__�_4'0_-______ --- (1J <br /> Distance from foundation_ <br /> ------------------- <br /> to nearest lot line----------------- F -S3 <br /> ❑Seepage Pit: Distance to neares1well----------------Number of pits______________________Lining material-----------------------Size:°Diameter_____.___._--__-_...__,Depth-_____.______________________---- s a <br /> Cesspool: Distance from nearest well---------------[Distance from foundation------------ <br /> !.-.-.Lining material-----------------------------------i <br /> Size: Diameter_______1__._____._ De th_____________ __ 1_ 9 Li uid Ca aci els. In <br /> ❑ ---------------- p ..----• ----------------- 9 P ty----_--------------• 9 � , . <br /> .._:.:.T _." t <br /> Privy: Distance from nearest well---------- --------------------------------Distance from n esfBuilding,-•-------------------------_------------- 6 <br /> ❑ Distance to nearest lot'line "._' $'"" <br /> 1 � <br /> Lip <br /> Remodelingand/or repairing (describe):--------------------------------------------------------------------••-••••...•--------------------------•---------•---------•------•-------------_--- <br /> ----------•---------•----------------------•--••-------------• !- ----------------------------------------------------------------------------------------------------------------..._.........--------------------------- i <br /> 1 <br /> a <br /> I hereby certify that I,have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. j <br /> (Signed) ®�}� Lr' _. ,S,�l�l.S-----------f �, Owner and/or Contractor Ik <br /> By:........................ R- r9" ---------------------•--• ----------...:._-------(Title)._.. — ------------ - <br /> (Plot plan, showing size of lot, location of system in relation to wails, buildings, eft can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- ----------------------- --------------------- DATE <br /> REVIEWED BY...............•-_----------_-------{ -----•--------------------- -- --- -- --- . DATE.... <br /> 7 �---- <br /> BUILDING PERMIT ISSUED............................................... ----------- DATE------------ ---- <br /> Alterations end/or recommendations: ------------- --------------------------- •---•-......----•-•---f-------- -----�-{-------•-----------------------------------.._.. <br /> -------•.....................................-------------------- ---•---------------------------------------------------_.-------------••----------•--------•..-.--•--•----•---........-----------••-------..-------.._.... <br /> ..................................•----._......__ ................I-•-•---------------------------------------------------------•-••-•----------..-.---__--.-.--.-------------------••--------..._.-..----------•------------- <br /> r <br /> ------------------------------------- --- - ...... ----------' <br /> 6FINAL INSPECTION BY:------ -" --._._ Date---------------------------- ------------ ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT I <br /> 130 South American Street 300 West Oak axeet 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,Callfornla Manteca,California Tracy,California w I <br /> ES 9 REVISED S-$9 ZM 9-61 ATLAS <br />