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FOR OFFICE USE: <br /> - - ----- <br /> -4--- -= <br /> ------- -----------r <br /> APPLICATION10A SANITATION PERMIT Permit No. <br />------------------------------------------- <br /> (C6rnplete in Duplicate) <br /> ------------- -------------------------- TQ� Date Issued ---- <br /> ------ -------------- This Permit-Expires 1 Year From Date ISSUOU <br /> Y L I <br /> Application is hereby made to the Son 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 /> -­-- - <br /> JOB ADDRESS AND LOCATION---/ ----------------------------------------------------- - <br /> --•-------••----•-----_------- ------------- <br /> - - <br /> Owner's -----------------------------------------------------_------------------------------------- Phone-------------------------------- <br /> ..........L............... <br /> Address----- —�W�� f ----------------------------------------•--=---:--------_:•----------- ---------- <br /> Contractor's Name----------- ----------------------------I------------------------------------------------------------ Phone--------- ---------------------- <br /> Commercial [j Trailer Court.[J' Motel 0 Other 0 <br /> Installation will serve: Residence -Apartment House 0 <br /> I t -/--, Lot size ---------------------- <br /> 7�u jF <br /> ' Number of living units: JL_ Number of bedrooms S_ 'Number of _x ---------- <br /> ZA&ft. 4 <br /> Water Supply: Public system El Community system [Er Private [f Depth to Water Table 7-9-- <br /> Character of soil to a depth of 3 feet; Sand El Gravel F-1 Sandy Loam El Clay Loam 0 Clay C1 Adobe 2f Hardpan El <br /> i [�r No [3 FHA/VA: Yes po' No 0 <br /> Previous Application Made: (If Ves,date---------- - No 2r New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , <br /> (No septic tank or cesspool permitted,-if,public sewer is available within 200 feet.) <br /> --------------------- <br /> ------Distance from foundation----/A_,,.__-M? <br /> Septic Tank: Distance from nearest well C a p a c i ty�"_Irlho---------- <br /> No- of compartmenfs-__x--------------------Size-_AI17'X'A(1P_1�'1---Liquid --------- <br /> Dis�fance from nearest --------Distance to nearest lot line--------I...... <br /> Disposal Field: well'." '_-_._Distance'Distance from founclat Width of french_A. .......................... <br /> 'Number of_lines____:_---- --- -------------- <br /> ---------Length of each line...Zo----- <br /> AP�____:_.._Total length----/J-------- <br /> Type of filfi:�r_mater:,ia.1_ZyLX-_4A__Depth of filter material I — I- 1� 1� . <br /> A �- I ce to nearest lot lige____________-.. <br /> Seepage Pit: Distance to nearest Distance.from foundation.A .. <br /> -------—------------ I Y <br /> k Z$" ,4 K <br /> Number of pits rial---XP --------------Dept - -- ----------A_ <br /> jj:�&---Size: Diameter <br /> -- --------------Lining mate V <br /> Cesspool: Distance from nearest well_____ ___________Distance from foundation- _-___--,_____.Lining material_---,___________________________-___. <br /> ❑ Sze: <br /> aterial-------------------------------------- <br /> Size: Diameter----- -------------------=Depth------------------ -------------------- --------------Liquid Capacity-------------•-----------=--gals. <br /> 4. ------------------------------------------ <br /> Privy: Distance from'nearest well-------------- --- <br /> -------------------- <br /> ------------- --------4---------- -----------:-----------------­-I------I--------:-------------------- ---------------- <br /> Remodeling and/or repairing (describe):-------------- ---------------------------------- -------------------------- <br /> - <br /> ---------------I----------------------------------------------I------------------------------------- ---------------------------------------- <br /> --------------------------------------:---------------------------------------------------- <br /> •-----------•-----F--------------------------------------------I--------------------------------------------------------------------- <br /> ---------------------------------- ------------------------------------------- <br /> ----------- ------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this-application and that the work will be done in,accord anee with San Joaquin County <br /> ordinances. State laws, and rules and regulations of fhe.San Joaquin Local Health District. <br /> ------(Aboftf=!;S�or Contractor) <br /> [Signid)�-----— --- <br /> r ------------ <br /> ---------------------------(Title)-- ..................... . <br /> By:_---------------- ------------------------------------ <br /> --- --------- --ion to <br /> ion,of system �re relation wells, buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size. of lotjocatl <br /> 4 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ------ ----------------------------------------- DATE-----'--- ---------------------- <br /> ----------------- ------------------- ---------------------------------------- <br /> REVIEWED BY----------------°-------- -------------------- --- -------- 7------------------------------------------------- -- <br /> - <br /> DATE <br /> BUILDINGPERMIT ISSUED--------------- ---------2------------—-------------- ------------------- DATE------------------------------------------------------------- <br /> ----------------------------------- ------------------------------ <br /> Alterations and/or recommendations:------------- --- ---- --------------------------------------------------------------- <br /> .... ... ------- ------- -------- <br /> ------------P------ - ---------- ------c--------------- ------ <br /> ---- --- ----------------------------- <br /> ----------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------ <br /> -------- ---------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- -- <br /> FINAL INSPECTION <br /> Date :.--` {--'- '- <br /> 4. <br /> - --------- <br /> SAN JOAQUIN LOCAL HEklz­TWDISTRICT, <br /> 130 South American Street -if 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Locil,California Manteca,California_::L1,.,E Tracy,California <br /> E6-9 REVISED 8-59 r,P.CD 2M 6-60 <br />