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FOR OFFICE: SF7 �y <br /> -- 3 j �. <br /> -�----. ... Permit No. ............ .•- -•- <br /> ►�. _ APPLICATION FOR SANITATION PERMIT r <br /> 5 <br /> (Complete in Duplicate) Date Issued ------ <br /> i <br /> ___.. l----- 3 <br />---------- -- -- - <br /> - - - <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 /> JOB ADDRESS AND LOCATION. = RSA �. -"-----------------------------` T-Q1 ? <br /> Owners Name..M.A.--4-M'_1J2S.....-----�•-�-jn-IF S----------�-=t`� 'T <br /> ------ Phone. c�C--`f <br /> ?'1 <br /> Address---............. _�•-�1�-tC ------------------------------ -------------------------------------------------------------•------------------------------•--••----------•-----•-•----•--•--.-•--- <br /> le <br /> Contractor's Name----------4 ' ----------- 1�.1.S/y---- ---- <br /> Installation <br /> ---- . =" 1 Q <br /> Installation will serve: Residence jj3l"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/-___ Number of bedrooms,,?_-- Number of baths -_1..._ Lot size ...7-J7._-..X.-40.0......................... <br /> Water Supply: Public system Iff"Community system ❑ Private ❑ Depth To Water Table kPft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay [Adobe[/Hardpan ❑ <br /> Previous Application Made: (If yes,date-_----._--.--._----) No � New Construction: Yes E] No j?' FHA/VA: Yes E] No @a,PP c n <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _ r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----------______.---------------------------------- <br /> ❑ No. of compartments---- ------------------Size--------------------------- -.-Liquid depth_--------------- ---------C,7� City-----•--------------- <br /> Disposal FieDistance from nearest well__#%*lq _,Distance from foundation...4�''__...__.Distance to nearest lot line--- ..... <br /> Number of lines--•-----------J------------------Length of each line---------..3P------------Width of trench. y�� <br /> CtJ4 Type of filter material-_. --------Depth p h of filter material------1B.._.....Total length_____________________ ......... <br /> SeepagPim t Distance to nearest well �✓4fR±' _-.___Distance from foundation__.-! ._�_.__..Distan�a to nearest lot line_.. ....... <br /> ® Number of pits.__.__...__._ _____Lining material...1L�°K-_:.-Size: Diameter___:. ------------ ......... f� <br /> Cesspool: Distance from nearest well-----_-----------Distance from foundation-------------------.Lining material----------------------.-------------- <br /> cls. <br /> ❑ Size: Diameter----•---------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------g <br /> Privy: Distance from nearest well------___-------------------------------- _--___Distance from nearest building---------------------------------.------_. <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------ ----------- <br /> i s T i --------•-- <br /> Remodeling and/or repairing (describer-------�A2_.D------�..- -�X------------•�-�------�--Y�r��-'��---•------•--------------•---•----•----- <br /> --------------------------------------------------------------------------------------------------------------------------------------- - <br /> ------------W------------W-----------------W----W---------------------------------------W-W------------W-----W----W-----W-----------------------W----------------­ <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- <br /> I hereby 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 of the San Joaquin Local Health District. <br /> ,p( Own r and/or Contractor) <br /> (Signed)-- Y`= ' ( / <br /> By: - Tale <br /> -------------------------------------------------- - .. <br /> ( � ---------------------- - <br /> (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). <br /> OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ - `j --------- -----•------------------------ ------ DATE 'S - <br /> REVIEWED BY DATE <br /> - . ....w. ....------ <br /> BUILDINGPERMIT ISSUED---------------------------------- --------------------------- DATE-------------------------------------------------- <br /> -Alterations and/or recommend'atio - ._.._.. �. <br /> ------------------------------- <br /> � ' ----•--•---e.,�1"..:.. ''Zt -• = C Vic' <br /> / - _ <br /> -----•-•------------------------------------------------------------------ -----------------------•-----------------•---------------- ------------------------------------------ <br /> -------------------•-------•------------ ----------------------•------- ---------------------------------------------------------- --------•------•------ <br /> --------•---------------------------------------------------------------------- ----- --------- ------------------­---------- <br /> FINAL INSPECTION BY:.------ -e`4=- ------------- - Date_-----_------------- Z ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />