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FOROFFICE USE: <br /> ------------- -------------------- ---------------- ---- <br /> - ---------- <br /> ------------------------ ------ APPLICATION FM SANITATION PERMIT Permit No. -77 <br /> ------ -------------------------------------------- (Complete in Duplicate) Date Issued <br /> ------- -------- -------- ---------------------­­_ This Permit Expires I Year From Date Issued 0 Z / <br /> Application is hereby made tothe San Joaquin Local Health District for a permit bo co tract and install theerein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> 01 <br /> , A__e,--_ ---------- ------- <br /> JOB ADDRESS AND L, N <br /> Owner's Name <br /> -------------------------------------- -------------------------------------- <br /> Address.-. <br /> ----------------- ------------------ --- ---------- <br /> ------ -------------_---------t------------------------- ----- -------------------------------------- <br /> ILI, Contractor's Name------------------ <br /> ------------------------------------------------------ 7 <br /> & - - <br /> Phone <br /> Installation will serve: Residence Apartment House E] Commercial -trailer C <br /> ourt [:] Motel E] Other E] <br /> Number of living un-its: NuUer of bedrooms a3--- Number of baths ---4_1 ------8t size ? <br /> Ii ---------­*------------------------ <br /> Water Supply: Public syst6m E] Comimunify systemIE] PrivateDepth to Water Table _?A- ft. <br /> 9 !�,� , <br /> Character of soil to a depth of 3 feet: SancIC] Gravel Ej SandyLoamE] 'Cla'yLoarnN6 ClayEl AdobeF <br /> i 1 1. ❑ � It _] Hardpan 0 <br /> Previous Application Made: (If yes,date--..---"---..._.-.".) No E] New Construction: Yes [] No FHA/VA: Yes E] No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> (No septic tank or cesspool permitted.if public sewer is available 'ithin <br /> � 260 feet.) <br /> w <br /> pfi Tank- Distance from nearest well------------------Distance from foundati� <br /> No. of compartments---------------------- I on_-----------------Material-------------------- --------------- ----------- <br /> ----Size---------------------------------Liquid depth------------------_---------C paci <br /> fy------------------------- <br /> Id: ADistance-from nearest well.574--------Distance from foundatiorr4 ---..__ .Distance to nearest lot line---- <br /> *fTank*l Number of lines=-----/----------- <br /> Length of each ------------Width of trenci�__00?1----------------------- -- <br /> Type -of filter material._,_. ._Depth of filter material__49----------Total length---------------------Jga_ <br /> Seepage Pit. JDisfance to nearest weli_A0_4..'_ Distance;ifrom if unclatio -- ----------------Distance to nearest lot <br /> --- ---- 3 3 Oj i- <br /> Nurnber.of pits. ng ma+erial-' a ------------------Depth......R <br /> ---/----:---------Lini Size:'Di4mefer'__ <br /> 09 __ 411"�X' - -------------- <br /> Cesspool: D;stance from nearest well-----------------Distance' from'foundation.-.._...' ----------Lining material..-------------------- <br /> .7i ---------------- <br /> 0 Size: Diameter--------------------------------------Depth----------------------- .1. <br /> ----------Liquid Capacity----------------------------gals., <br /> 'Privy: Distance from nearest well-------------------- <br /> --------------------------DistanLe from nearest building...._._..----.._.❑ to nearest lot line 4 <br /> - ---------------------- --------------------------------------------------------- ------------- <br /> Remodeling and/or' repairing (describe):-------------------------------------- -------------- <br /> 9 ---------------------------------------•------------- _----------------------------------------- <br /> ------------------------------------------------------------------i---------------------------------------------------------------t <br /> ----------------------------------------------------------------------------- <br /> ------------------------------ ------------------------------------------ --------------- ---------------------- - - -------------- ................. <br /> -------------------------------- <br /> ------------------------------------------*---------------------------------------------------------------------------------- ------ <br /> ----------------------------------------------------------------- <br /> ---- ------ - --- --- <br /> I hereby certify that I have prepared This application and that the work will be d.one in accordance w-ith-_San-_Joaquin. - -_County- <br /> ordinances, 4t99 laws, and rules and regulations of the San Joaquin Local Health District. <br /> 4 <br /> (Signed)•-------- 4`' .._ <br /> t - <br /> 0 AjA/ .� <br /> ---�-------------------------I-------------------­--- wner and/or Contractor)1- ------ - ------------------------------------- <br /> By:------------- - (Title) -- ------------------------------- <br /> - -------- <br /> (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------------------ <br /> APPLICATION ACCEPTED BY------------ <br /> -- DATE- <br /> REVIEWED BY------------------ ---------------------------------------- ------ - <br /> ------------ - -------------------------------------------------- ----------- DATE-------- - <br /> BUILDING PERMIT ISSUED--------------------- :----—-------------------- ----------------- HATE------------- <br /> --and/or recommendations:.------"-----..__. <br /> .............................................................................. .._-•_. 3 <br /> ------------------------------------------------------------------ <br /> ecommendations:------- ------ <br /> ---------- <br /> ----------------------------------------------------------------- T------------ ----------------------- ------------------------------------------------------------------------------------ ------------- <br /> -----------------------------------------­--------------------------------------------------------------------------------------------*---------------------*------------------------------ -------------------------------- <br /> I-----------------r---- ------------....._--I--.------- --------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------ ----- --------------------------------I------------------ - --------1------- -----------------------------------------------------------­­-------------- -- ------------------------- <br /> FINAL INSPECTION BY:.,��_._� ------------- Date--------------- <br /> . ..........�7------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave, 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 3M 3-'63 F.P.C:U, <br />