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R FACE USE: ' <br /> F <br /> APPLICATION 65, 11 SANITATION PERMIT Permit No. V/---5P <br /> --------------------------------------------------------- <br /> I -- ------------------------------- --------------------- (Complete in Duplicate) <br /> Date Issued S .1--L ..; <br /> .-_-.--- This Permit Expires 1 Year From Date Issued SG <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. <br /> JOB ADDRESS AND LOCATION-P0 Q, - - -- _ ;;�!;4j f <br /> 44P P <br /> Owner's Name-----7.4- ------- -& -----�r f'Q - `'s---------- ------ --------------- ----- <br /> Phone-.. ---•------------- <br /> Address---- f ... --/--- --------------------•--•------------------ ----------------------------------------------------------- ------------- --------------:_---- <br /> G 9�d <br /> Contractor's Name---------------- <br /> -ei.s ----------------- ------------•-------- Phone----------------------------------- <br /> Installation <br /> ---- ----------•---------Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [3 Motel C] Other� 0—Foce <br /> Number of living units: -------- Number of bedrooms -------- Number of bathsc�. _ ___ o 4size -----1Q_4----- ----------------_._--_-_ <br /> Water Supply: Public system ❑ Community system ❑ PrivateK Depth to Water Table IV& ft. � <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan-0 <br /> Previous Application Made: (If yes,date---------------- --) No ❑ New Construction: Yes ❑ No X FHA/VA: Yes ❑ No' <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: P <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> pti Tank: Distance from nearest well--.---__----:--Distance from foundation--------------------Material-------------------------------------.-- ----- <br /> No. of compartments-------------------------Size--------------------------------Li Liquid de th--------------------------Ca Capacity ---- <br /> �°" <br /> �}-q p, P tY �. <br /> Disposal Id: Distance from neares well�dl?- Distance from foundation--- Q. .-_.Distance to nearest lot <br /> Number of lines-__- -_ Length of each line�-. �d ;�____--.Width of trench- r - l-._ 4 <br /> Type ofLCter material---._. y46 <br /> __Depth of filter material_ -S_-___------Total length"._ ___ - ---=~- <br /> IJ----' <br /> Seepage Pit: Distance to nearest weII,�C��_--.-.--_Distance from f undation-�,0-..----:"Distance to nearest lot line------ <br /> Number <br /> -.�. <br /> Number of pits------I-------------Lining material- � ----Size: Diameter-j�-.__rWbepth_i-z2->�----- ---{----- P <br /> Cesspool: Distance from nearest well--------------_-Distance from foundation.-------------------Lining material---.----------.----------------------- <br /> ❑ _ .. ' Li uid Capacity gals. <br /> Size: Diameter-------------------------- ------ Depth"-= - ci P Y <br /> ' Privy: Distance from nearest well---------------------------------------------- -Distance tram nearest building--------------------------------- <br /> � <br /> i ❑ <br /> Distance to nearest lot line-------------------------------------- <br /> ------ ------------------- -.�----------------- ------------------------------------------------------------------------ -------- <br /> Remodeling and/or repairing (describe}:_-` -'-'Q- F <br /> ---------- - ----- <br /> ------- - cy�s <br /> ----------- —�--- ---•------ --- ------ - <br /> -� ---- - - <br /> r---�----- ----:-------------- ---- <br /> --- <br /> --- ----------- ----------------------------------- , <br /> - ---------- - ---------------=-- -�: <br /> �''"�-----�--- y' <br /> I hereb rtify that I have prepared this application and that the rk will be done in accordance with San Joaquin County <br /> ordinance tet laws, and rules and regulations of the San Joaquinacal Health District. . <br /> .,. ..' <br /> (Signed)-----�_5AAak----------- '------ - - <br /> ------ -------- -------------------- ---- -- ---- Owner and/or Contract") <br /> dA <br /> 1 ----(Title)--- <br /> BY: ---=-- .--- = 7 - <br /> (Plot plan, showing size of lot, location of system in-relation to well , buildings, etc., can a placed on reverse side). <br /> I FOR DEPARTMENT USE ONLY 'L <br /> APPLICATION ACCEPTED BY--_-:,,_.=/ ; - ' --------- -----------------`--= �------------ DATE-----' W.�� = ' <br /> DATE-----------BY------ - <br /> = BUILDING PERMIT ISSUED------ ------------------- ----------- - ------ ------- DATE--------------------------- -- ------------------------------ <br /> Alterations and/or recFommendations: � 1.__E- ---------- `(''t �' - '� .-_. `` ter'`'-------- <br /> �`�' ��Wiz - --.�r l : ------------------------------------------- -------------------------------- --------------------------------•-`------- <br /> ----------------- ` ---- <br /> FINAL INSPECTION BY:----- -------- -- ----���'' .---- Date--... � . <br /> i AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4 <br /> } 1441 E.Ha:_lion Ave. 0 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> '"- <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> {y�� <br /> ES 9 REVISED 8-59 3M 3-63 F.PX93- 1 <br />