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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ZiI7 <br /> ....__.. <br /> ------------------------------------------------------ (Complete in Duplicate) r <br /> -------------------- -------- ----- ------------------ -- <br /> This Permit Expires 1 Year From Date Issued Date Issued <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_ - <br /> Owner's Name-----�. R 5 ------- .- 1 �1---• ----->-------------------- --- Phone.................................... <br /> Address... o. ------z-:�_. --•-- ---- _! ?A......... -?--01-H---------•-------------- <br /> Contractor's Name------6_.W__vAStJy, <br /> ------••--•---------------------------------------------------------------------- Phone .............-- <br /> Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---I.... Number of bedrooms Z___ Number of baths A.__ Lot size ----(o.7Z�-.Water Supply:Supply: Public system l& Community system ❑ Private ❑ Depth To Water Table k_') ft, f <br /> Character of soil toa depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [I Clay [-IAdobeRg Hardpan ❑ <br /> Previous Application Made: (If yes,date--------- ----------) No ® New Construction: Yes X No ❑ FHA/VA: Yes ❑ No Dl <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. ,. <br /> Septic Tank: 'Distance from nearest we4t�__Size_ <br /> tance from foundation-__ <br /> _ Material._�Q�i, .................... <br /> x1jNo. of compartments__.--_--- -- .�t_.X..III--X.$`_-- uid depth.__---_-7.�-----•----�apacity... <br /> �O/ <br /> Disposal field: Distance from nearest well..I Distance from foundation---L_G.ti---------Distance to nearest lot line-_, 1---_-- <br /> . <br /> 41 <br /> Number of lines----------2•�.______________ _- Length of each line__��.. �____ I > <br /> - 9 `tZ � Width of trench.---Z,.�__-_-•--------------- <br /> Type of filter materiaj _�_ l:GI� Depth of filter maferiel_�__-j.g_! '._._.Total length........gQ..1_.____.._.__ <br /> -------•-- t <br /> Seepage Pit: Distance to nearest well___'ILW - 'I 1 <br /> ��Ilk-___-_Distance.from.foundatiorL_.!.Q_____.__..Dist_ancel to nearest lot line...�__..___� \ i <br /> Number of P e. ,Diameter__. <br /> {' 3 ..Depth - --------- --- <br /> 1 _______Linin mafierlal':� _ _CQ_C Size. �`� �� �� � <br /> Cesspool: Distance fromsnearest well-----------------Distance from foundation_____________!_____.Linin material --------------- <br /> ❑ Size: <br /> ❑ Diameter--------#------�-----.-_-----------------Dep-t�h-----------------------------------------.---------�--- -- <br /> F----Li uid Capacity gals. <br /> Distance to nearest lot line---______________Privy Distance from nearest well_-________________-_-______y__iV_----_.______Distance fromneares+ building-----------------------•---------------- <br /> -- <br /> , <br /> ------•--•-- - ------••---------------- ------ <br /> Remodeling and/or repairing (describe)__________________-----.___-. I <br /> ------------•-------•-•---- _- <br /> •-----•--------------------•------- t <br /> --------------------- <br /> P P 9 �P ... ;-•----------•- -=-----•----------------•--------------•------------------- l <br /> I herebycertifythat I have prepared this application and +hat the work-will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules'dnd regulations-of the San Joa uin Local Health District. <br /> v F <br /> (Signed)- i <br /> ------------ -------------------------....(Owner and/or Contractorl <br /> i <br /> _ ..-- ..---(tria) <br /> ------ #. <br /> (Plot plan, stowing size of lot ocation of system in relation o wells,'buildings,etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY } <br /> APPLICATION ACCEPTED BY---CY_,-_-- - -' __ DATE---- ---_ C)_• -- <br /> REVIEWED BY---------------- -•- DATE------ -"-------- <br /> ----------------- ----------------- <br /> • -------------------------------------- <br /> --T--' ._ �.. r <br /> BUILDING PERMIT ISSUED------------------- <br /> ---`--------------•-------------------------_----------------...------------------- DA•TE------------------------------ <br /> Alterations and/or ommendations:- E------ L; .�? �2='' ' �� <br /> s <br /> --- ----- <br /> `-t� L .=."`�-c� (rG = � ----•--C----- --•-•� �~� ``� ---------- <br /> --------------------- <br /> ter ` <br /> — �� `� <br /> S <br /> -•-------- ---••- <br /> FINAL INSPECTION BY:--- � - - � k.1 ,; ' -- Date --- <br /> { <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT I <br /> I 30 South American Street 300 Wort Oak Srreet 114 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ..ES 9 REVISED 8.59 2M 5-62 ATLAS <br />