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FOR OFFICE USE: <br /> N o <br /> FOR SANITATION PERMIT Permit . .... .......... <br /> ----------------- --- APPLTION F '. C711 - <br /> ------------- (Complete in Duplicate) Date Issued <br /> ------ - ----------------------- I This Permit Expires 1 Year From 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 /> -IV _ - e�� T""/_ ............................. <br /> r P....................................................................... <br /> JOB ADDRESS AND LOCATIQN---------------/------ <br /> Owner's Name--- 47V....I....... ----------------------------------­_­---------------------------------------- Phone--------•---•------ <br /> Address-------------- ..................................................................................................................................--------------------------------------------- <br /> Contractor's Name---I Z ........ ......... <br /> ............................................................................. ............................---------------­--- Phone.. <br /> Installation will serve: Residence [Apartment House M Commercial E] Trailer Court C] Motel F] Other [I <br /> Number of living units: _1.... Number of bedrooms &_ Number of baths _�L.. Lot size ---1j5?44,!I!ad................................... <br /> Water Supply: Public system C-] Community system [-] Private 8`16epth to Water Table ..'(9ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam F] Clay Loam [:] Clay [&-Adobe C] Hardpan C] <br /> Previous Application Made: (If yes,date-----------7--------) No 11__ New Construction: Yes R?'lZo F] FHA/VA: Yes 0 No 9?' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic;an k: Distance from nearest Distance from foundation/49-------------Material.-OO 1a4..t__110L................ <br /> No. of compartments......9------------------Size_,S_f ___Liquid clepth---4------------------Capacity..14 <br /> Disposal, Field: Distance from nearest well-/00-------Distance from foundation./4.............Distance to nearest lot line_�:...... <br /> 0511" Number of lines----/----------------------------Length of each line-----r_jq-----------------Width of trench--_Z. ---------------- <br /> Type of filter material� _-__-_-_-Depth of filter material__/X--------------Total length......?.a-------------­--------;..... _S> <br /> Seepage Pit: Distance to nearest well-_10-0--(---------Distance from founclation-ta..............Distance to nearest lot line__4 ------- <br /> 19-1 Number of pits-.-/-----------------Lining mate ria ------Size: Diameter....3 —-_---------- <br /> Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material-__-_-_----_______----_.-_.___-___--. <br /> Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------_------gals.gals. <br /> Privy: Distance from nearest well-_-_._-._._.__------------------_--_-__--_Distance Distance from nearest building._________----_.___-______--:-____--_--. <br /> ❑ <br /> uilding----------------------------------------- <br /> 0 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------------------------................................. <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 4 , , <br /> --------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------­---------------__..................................................---------------..................................------------------------------------------------------------- <br /> I here4y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations f An San Joaquin Local Health District. <br /> (Signed)------------------------------------------------------------------/___ ------------- ---------------------------------------------------------------------(Owner and/or Contractor) <br /> By:.............................................. ----- --- --------------------- ----------------------------------------------(rifle)-----------------------------------___--- ------------- <br /> (Plot plan, showing size of lot, locafflon of system in relatio to wells, buildings, etc., can be placed on reverse side). 7 <br /> FOR DEPARTMENT USE ONLI <br /> APPLICATION ACCEPTED BY - 61-45- <br /> ---------------- <br /> REVIEWEDBY--------------------------------------------- --------------------- -----------------------------------:----/-----------..... DATE---------------- ---------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------I----------------------- - -- --------- r �.TE------------------------------------------------------------- <br /> Alterations and/or recommendations:_...___.._ / -_?-:�r <br /> 7_ ---------------------------------------- <br /> ------------------------------------------------------------------------ -------------------------- ------------------------------......................................................................................... <br /> ­----------I--------------- ---------------------------------------------- ---------------I-----------------------------------------------------------------------------------­--------------------------------------- <br /> --------------------------------------•-----------------•------------------------------------------------- .....I------------ ----------------------- ----------------------------------------------- -----------------_-- <br /> ------------- ---------------------------I-------------------------------------- -------------------- -------------------------------------------------------------------------------- ----------------------------- <br /> FINAL INSPECTION BY:.. ----- -- ------ --------- --------------------- Date-------- <br /> .........../------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. f300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> FS 9 REVISED 8-59 3M 3`63 F.P.120. <br />