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FOR OFFICE USE: <br /> ------------------------------ ---------- --------- <br /> . ........ --------------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. -.47 .141r <br /> --------------------------------------------------------- (Complete in Duplicate) <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 clonsf rucf qnd 'install the work herein described. <br /> This application is made qliarce with County Ordinance No, 549. f <br /> 'c <br /> p <br /> JO TIZ <br /> D LOVATI <br /> B A�OhliD A <br /> --- ------ - ------ ------ eF. 6M_ <br /> Owner's Name_-. _ ----------- <br /> -- ------------- Phone.... ............................... <br /> --------------- ----- <br /> Address..............ff_.re_r._3....... ----X------- <br /> ---X----------71e-----------------M.Q&TE <br /> Contractor's Name--•---I Cr_-Z6Dj <br /> --------------­ ----------- Phone............................... <br /> Installation will-serve: Residence OApartment House E]---C— mercial [j Trailer Court El Motel El Other <br /> N mber of baths 2� Lot size ... . ... ........ <br /> Number of living units: Number of bedro /M�'s ---3,7N , 'N <br /> ................ <br /> Water Supply: Public system ❑ Community syslem E3---Kv�'ate 9TO"Depth TO Water Table,9;7—ft. <br /> Character of soil to a depth of 3 et: Sand WGravel C] Sandy Loam Clay Loam E] Clay [3 Adobe[] Hardpan C] <br /> Previous Application Made: (If yes!dc te-------------- -----) No F��New Construction: Yes Le—<o 0 FHA/VA: Yes E] No W�-� <br /> TYPE OF INSTALLATION ANC(SPECIFICATIONS: <br /> I -_ - 0 <br /> (No septic tank or ces'-sp-69'I 'permitted if public sewer is availableL within 200 feet.) <br /> SepficXnk: Distance from nearest well-__, ----Distaqqe from foundation-----/V--------Material...00.1� <br /> E5 No. of compar&Ats------*2-------------Size.xX1P__X L57 Zl ,,e <br /> Liquid depth----- <br /> 7,/-Z---CaPacity:.�i�� <br /> Disposal Field: Distance frorn larlest well__ .570-.-Disfance from foundation....................Distance to neafg.st lot line.------7) <br /> Number of fine <br /> )------/----------------------Length of each line-------_1V0...........Widthof'french --------a <br /> Type of filter m ferialr.-)?_(74:��w..Depth ofxfiIter-materiaI___J_q_"-'-__�T,6't th........ -t----7------------ <br /> al leng ------1/61.0------------------ <br /> 0 <br /> U <br /> Seepage Pit: Distance to newest-well'��-Distanceifraruf, <br /> Jndation..........o000_0. ".Distance <br /> :7 1. to nearest lot line--"_""""._....-__ -AZ <br /> El Number of pits-------------==__7...:Lin ifftTmaterial-Y------------------ ---.Size: Dia'mlker-----------------------Depth---------- <br /> Cesspool: Distance from nearest well-----------------Distancgrbfrom f ndation ------------ <br /> -- --_Lining material------- ------------- ---------- <br /> ---- <br /> i uid Capacity ----------- <br /> ..gals.ESize: Diameter -- <br /> Privy: <br /> Distance from nearest well--------------------------- —------------------Distance from eares"f building----------------------------- <br /> C1 Distance to neares lot Ii,e_ ------------ <br /> - ---------- ----------­­----------------------------- <br /> Remodeling and/or repairing (describ ------ ---------------------------------------- <br /> ----------------------- <br /> --------------------------------------------------------------- --------------------------7---------------------------- ---------------- I--------------------- -------------------------------------------- <br /> -------------L--------------------------I----­­-------------------------------- <br /> ti <br /> -------------------------------------------------------------- <br /> ---I------------------•---------------------•-••--------I---------------•--------------i-----------•----•--------N2`--------------------------------------- <br /> -------------------------------------------------------- ------I---•------•----= <br /> -----I--------------- ......A--------------------------------- <br /> the _ "'�eKfvi�WSan Joaquin County <br /> aced this application and that -------M 'Io accordan <br /> I hereby certify that I have pr iia_woriiMe_ne in <br /> ordinances, S4fe laws, and lesold regulations of the San Joaquin Local Health District. <br /> (Signed)-------- ---- — -------V--- ---------------------------- (Owner and/or Contractor) <br /> ........................................................ <br /> -------------------------------------- ----------- --�- <br /> --- --- Tme):--- <br /> (Plot pla' shooing size Of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> -�APPLICATION ACCEPTED BY--------TTRX?-- ------------- <br /> . W r 11.r ------I-----­--------- ­----------------------­--- DATE--------- <br /> REVIE ED ------ ---------------- <br /> --------------------------- <br /> ---------------------------------------------------------------- DATE------------- <br /> a,PE <br /> BUILDINI �Q ED------------------------------------ ----------------------------------------------- <br /> _r-—-------------- ----------- ------ <br /> P <br /> Alterations and/or reco ncratijins:-------------------- <br /> ----------------------- <br /> 2A44----------- ----------fiJjq7_f--------C_ W& <br /> 40— <br /> ... ------------------ <br /> ------------------- ------------------------- <br /> -- <br /> --------- s--------- ------ <br /> ---------------------------- ----------------r------------- ---------- --- K OK <br /> - --- <br /> --------------------------------------- ------- ----- .. <br /> i-- -----I&----------------------------------------------------- --------------------------------- <br /> ---------••---------------------- - ---i <br /> .............. - -- --------- ...... .. ----I----- ---- - ----------------------------------------------------------------------_ <br /> FINAL INSPECTIDate------ <br /> -------------------------------- <br /> . . ...... Date------- <br /> ..... ° ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodir CaliforniaA. <br /> Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />