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APPLICATION FOR SANITATION PERMIT Permit No. <br /> ......... ... <br /> (Complete in Duplicate) o-/,/f I <br /> This Permit Expires 1 Year From Date Issued Date Issued Z-Z,-----7--- <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------3 2 <br /> ------------ ...... ---- ------------- <br /> --------------------1-­----------- ---------------------------- <br /> 11 14, <br /> Owner's Name---------N-7. -1qj9Pj-1>----------(50N.-- ----------------------- ------------- Phone------------------------------ <br /> Address------------• -------------ZP.!t-19--- ---------------------------------------------------------------------------- <br /> Contractor's -—-------------------------------------------------------------------------------------------------------------- Phone-----------------------....------• 1 <br /> Installation <br /> ..............I-------- <br /> Installation will serve. Residence ®--A­parfrnent House F1 Commercial E] Trailer Court [3 Motel E] Other E3 <br /> Number of living units: -1_____ Number of bedrooms Number of baths -_ tot size ---- ------- -P----------------------- <br /> Water Supply: Public system Community system [-I Private E] Depth to Water Table Tu ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E]/Clay Loam 0 Clay E] Adobe&--�ardrpan El <br /> Previous Application Made: Yes E] No E2" New Construction. Yes V?*No M FHA/VA. Yes F No <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 well--'---Distance from fouadaf4on----/--D--------Material---)-: JEpwoco------------ <br /> -A- It 0 .1 <br /> "N No. of compartments-._-- Si,,--5xb-x,--!�----Liquid depth------7------------------Ca pacify---59 aQ----- <br /> Disposal Field: Distance from nearest-..well Distance from foundation---/-0---------Distance to nearest lot line .157 <br /> -----Length of each line-----�5-t---5-----------Width of trench______ __ CU <br /> 11,4. Number of lines -0 �j <br /> Type of filter m -------Depth of f4er mate ria ---Total length---------�;Z ---------------- <br /> r 16 A CA) <br /> Seepage Pit: Distance to nearest well------777 --------Distance from foundation___________________ Distance to nearest lot line----------------- -1D <br /> 171 Number of pits----------------------Lining material-----------------------Size: Diameter_----------------------Dept h------------_-------------------- <br /> Cesspool: <br /> ------ -------------------------- <br /> Cesspool: Disfance from nearest'we)l-----------------Distance from foundation--------------------Lining material_--_--______________.______.__-.-___ C, <br /> ❑ Size: Diameter---------------r------------------------ -------Depth----------------------------------------------------Liquid Capacity---------------------- ---•gals. <br /> 0 <br /> Privy: Distance from nearest well------------- -----------------------------------Distance from nearest building.,_._.____.______________---__-_-_____-. <br /> ❑ <br /> uilding----- ------------------------------------ <br /> F-1 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodellin or ri in <br /> Remodeling and/ epai (desc <br /> j ribe):------ - - --------MAY,­RF-------- --------- -------- <br /> ----------- ---------/Q-1----------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------I-----------------------------------------------------------------------------------------------------------------------11-------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------.t---------------------------------------------------------------------------------------- ------------- --------- ----- <br /> I hereby certify that.-I have prepared this application 64nd,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. <br /> (Sig (Owner and/or Contractor) <br /> --------------------------------------------------------------------- <br /> By:---------------------------------------------------------------------------------------------------------------------------------(rifle)---------- -------- -------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- ---7r- ------------------------------------------------------------- DATE------- = <br /> REVIEWED <br /> ATE-------- <br /> REVIEWEDBY--- --------------------•------------ ---------------------------------------- --------------------------------------------- DATE------- ------------------- -Z <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> Aiterations <br /> ATE------------------------------------------------------------- <br /> Alterationsand/or recorn rnendations---------------------------------------------------------------------------------------------------• ----------------------------------------------------- <br /> -------------------------------�5 T-'T-------------------------------- -------­­----------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- ----- - -- ------- ------ ---F?.r.N.C-(4------OX---------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------ ---------------------------------- .................. --------------------------------------------------------- -------------------------------- ------------------------------------------ <br /> --------------------------------- --------------- --------- -------- --R- --a--------------------------------------------------------7------------------------------------------------------ <br /> FINAL INSPE N BY:- --- Date------- -6-V---------------------- <br /> C -6;�p --- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2m Re-5e(3 8-'59 F P Cc. <br />