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FOR OFF-I-C E--USE-:---------------- PERMIT <br /> Permit No. <br /> - ­ ------ --- -1--- APPLICATION FOR SANITATION P <br />------------- - ----------------------- (complete in Duplicate) Date issued _�`///L�f� <br /> - -------------- <br /> - ---- --------I <br /> - This Permit Expires I Year From Date Issued <br /> -- -------- --- - <br /> --------- <br /> Application is hereby made to the San OJoaquin Local HealtDist rict for a permit to construct and install the work herein described. <br /> rdinanh ce No. 549. <br /> This application is made in compliance with County <br /> .- '. ../1"- os .......................... <br /> xw ....... . <br /> ----VO4-.21ax e 4 <br /> JOB ADDRESS AND LOCATION______ Phone------------------------------------ <br /> Owner's Name_._______ - .......... ........................... <br /> ­:���.... ........ . .......... I .................................................... <br /> Address. `�s --------------------------------------------------------------------------------------- Phone----------------------------------- <br /> -S----------------------------------------------------------------------- <br /> ❑ <br /> Contractor's Name..__ ........ -I Apartment House El Commercial [] Trailer Court [I Motel 0 Other <br /> Installation will serve: Residence 0 6 Ir <br /> Number of living units: A---- Number of bedrooms­4­ Number of baths .4---- Lot size -- <br /> ---------------- <br /> Water Supply: Public system 0 Community system 1:1 Private t- Depth to Water I Table 1.2-- ft. Hardpan 0 <br /> Clay Loam C] Clay Adobe[3 <br /> Character of soil to a depth of 3 feet: Sand Er-Gravel [I San' cly Loam 0 No [5' <br /> Previous Application Made: (if yes,date--_-__- No ET- New Construction: Yes [1­1lo ❑ FHA/VA: Yes 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> from foundation_-14-- Material--71-?. --------- <br /> --- <br /> ----- <br /> ----- <br /> Septic Tank: Distance from nearest well0­0 <br /> ___Dista Di t ---------- &-p-A <br /> iquid depth"_' --------------------Capacity...W10... <br /> of compartments----'2------------------Size.5X5--X--!j------------L <br /> qal- No. 7( Distance to nearest lot line.4-'--.--__--- <br /> Disposal <br /> 7.......... <br /> J-P -Distance fro idation b--------- 4 .7 <br /> Field: Distance from nearel wel -- ------ n ....Width of french <br /> Disposal- Number of lines--'-_#------1�1-------------------Length of eal) ine --------------Total length..... <br /> Type of filter materiaT 7AD <br /> materiae- --__-_____Depth of filter material)n ..........Distance to nearest lot line.--S--------- <br /> Istance to nearest well--5-0 Distance from foundati( ---- <br /> --------- Diameter-_T- Depfh-.------ --------------- <br /> Seepag D' -X-1 <br /> ,p,or 1 t Number of pits-----/----------------Lining materiall-WjCJ--'�­Size D am <br /> Nu ­rF---Z.)...... <br /> 0 foundation___---------"----- Lining material---------------T , gals <br /> Cesspool' Distance from nearest well-----------------Distance from founclatio ...................Liquid Capacity---------------------------- VIS <br /> 171 Size: Diameter_____--------------- ­­-------Depth-------- <br /> Distance from nearest building__________________________________________.. <br /> ----------- <br /> Privy- Distance from nearest well--------------------------- ------------------------------------------------- <br /> 11 Distance to nearest lot line---------------------------------- --------------------------------------------- --- <br /> Remodeling and/or repairing (describe):------------- 7 <br /> -------------------------------------------------------------------------------------------------- -----------------------------­-------------- ---------------------------------------------- ------ <br /> ------------ .............................--------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------- ---­--------------- ----------------------------------------------------------------------------------------------------------------­ <br /> --------------- <br /> ------- --------------------- ---------- - ---------- ----­------- <br /> ---------I--hereby- certify that I have--p-repar e.d­t.his.a.p-pl-i-c-ation.and-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 /> ----------------------------------- <br /> ...... (CkwaaLand/or Contractor) <br /> (Signed <br /> ------------------ -- --------- -------- ----- ------ ---- --------- <br /> --------------------------------------(Title)---------- ---------------- <br /> ---------- - --------------------- <br /> By:......................Y-e ..... ion of.-system in relation to wells, buildings, etc., can be placed on reverse side). <br /> (plot plan. showing size of lot, location FOR DEPARTMENT USE ON � I <br /> APPLICATION ACCEPTED BY--------------------------------------------- --------------------I—-,-- T­IC/ <br /> -------- PATE.------------------ <br /> REVIEWED BY--------------------------------------------- --------------------------------------------------------------------­-------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> ecommendations:-----(r -fF --- -h2-T7=>­,t <br /> ...14 ------A ---- <br /> Alterations and/or r 6t.�6 .............. . ----------------------------------------- <br /> ------------------------------------------------------- -------------------------- <br /> SE USE <br /> ............ .. <br /> -------------­------------------------------------ ------------------------------------------------------------------------M--------­-------------------- ­---­-------- <br /> --------------------- ---------I-------------------------------------- ---------- ------- - --------------------------------------------------------- -------------- ---------­---------------- <br /> ------------ ------------------ ---------- ---- ---- --- -------I---------- --- -- ----------------------------- -------------------------------------- ---------------------------------­ <br /> ---------------------------------------- ---------- . ....... ------------------- - <br /> FINAL INSPECTIL--- 4....P, <br /> Date------IL-o- 7 A ---------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 124 sycamore Street 205 West 9th Street <br /> 1601 E.Hazelton Ave. 300 west Oak Street <br /> Manteca,California Tracy,California <br /> Stockton,California Lodi,California <br /> LS 4 REVISED B-S9 3M 3`63 "'Co' <br />