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FOR OFFICE USE: <br /> I(.Y------------------- <br /> //. �j <br /> 6/ 9 . ,_ ___________________ APPLICATION FOR SANITATION PERMIT Permit No. ._�7sw <br /> ------------- ----------------:------- ------------------ (Complete in Duplicate) fo / <br /> Date Issued .... <br /> _.------- This Permit Expires 1 Year From Date Issued _. ..�. ._.6� <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. _`A <br /> .E'hsiZ t,r0�� <br /> JOB ADDRESS AND LOCATION- '497 l�/I� r-- •_Si�---P, h __ f e�e.�t--------------------•-------------_------------ <br /> ���Ai = .----- <br /> Owner's Name ---------------------- - <br /> =•-- Phone------------------------------------ <br /> Owner's Name <br /> �� ' � ------------------ -t-------_-----•----......-- ---------------------------- <br /> Contractor's Name------------- �t.T .� � Phone <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other ❑ <br /> Number of living units: ----- Number of bedrooms_�__ Number of baths Lot size ----/! <br /> Q� -- ---------- <br /> Water Supply: Public system ❑ Community_ system ❑ Private ®--[repth to Water Table .5� . ft. <br /> Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q-,Hz-rdpan ❑ <br /> Previous Application Made: (If yes,date...--------.----------)_ No E---New Construction: Yes g_--N'5 ❑ FHA/VA: Yes Q�No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:, <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T cf Distance}from nearest well__n:$_V_____Distance/from 17 <br /> --- <br /> ,.�� _ G ____ <br /> No. of compartmenfs....- -1 ....'.._.Size.. fes- 7 ___Liquid depth----- `../.��----Capacity-.._ C - ------ <br /> # ---i <br /> Disposal d: Distance from nearest well_._____}__.Distance from foundation_. .. <br /> ' .. �. Distance to nearest lot line...`............. <br /> Number of lines_._............. Length of each line.. -. -Width of trench.�. ..J._.___-__.-- <br /> Type of filter material.__-� ��_ GDepth of filter material---!L __��_.--Total lengthfa_ ..----___-__..._...-. <br /> Seepage P Distance to nearest well--- ------Distant om foundation-..- Distance to nearest lot lin ... <br /> Number of its Linin maternal_ _..Size: Diameter.s � ��� De th.t "__-_ <br /> P E g'.� tom, - p r. <br /> Cesspool: Distance from nearest, well.............._Distance from foundation...._____-_.:_.___lining material-_..--..__------.......__._.._...... <br /> ❑ Size: Diameter------- ----�'--------------------Depth---------.------------------------ ------------------Liquid Capacity-. .------------------------gals. <br /> Privy: Distance from nearest well..................................._----........Distance from nearest building-------------------------------------...... <br /> ❑ Distance to nearest lot line--.-I.°-------------------------------- ---•------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing_,(descriUe)---------------_ . _f ..__.._ ! .. - `1. '_..--- ------------------ <br /> -------------------------------------------------- - --------•----------------------------------- <br /> ------------------------------------------------------------=------------------------- <br /> - - -----------------------�' -----�-------------------------------------------------------------------------------- <br /> -------------------------------------------- <br /> ------ <br /> --------- - ------------------------ ------------------ -------------------------- ----- ---------------:------------------------------------- <br /> I hereby certifythat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> fi ordinances, State laws, a rules and regulati of the Sart Joaquin Local Health District. <br /> Y - - - ------- <br /> (Signed) Owner and/or Contractor <br /> ---------------------- ) <br /> By:-------------------------------------------- ��- - - {Title) -- ff <br /> (Plot plan, showing size of lot, location f s tem to relation to wells, ' Ings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> = �- '_: 9' -------------------- <br /> APPLICATION ACCEPTED BY____. -- -- - --------------------- DATE-__-..67-'-._-.._-._ - <br /> REVIEWED BY---------------------- -- - -- <br /> ------------------- --------------------------------- ------- -- -- - --- --- - DATE------------------ ---------- <br /> BUILDINGPERMIT ISSUED------_--• •---------------------------------------------------------------------------------------- DATE---------------------------- -- <br /> Alteti�o1n�s-acnd/or recom�.m�e"ndatons: ' <br /> --- - --- - --------�--- - - . f -'--------------------------------------------------------- <br /> - <br /> `-dG' c!-r------------�----�---------i � G------------------ <br /> -------------- - Y--- <br /> ' <br /> ------------------------------------ ---------------------------------- ---------------------------------------------------- ------------------------------------------------------------------- --------------- -- <br /> ---------------------------------- - ----------- ----`------- ---------------------------------------------­--------- ---------------- ------------- <br /> FINAL INSPECTION BY Date (� Q <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street ' 124'5ycomore 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.DD. •a: <br />