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FOR OFFICE USE: <br /> --------------------------------------------------------- _ <br /> -------- <br /> -----------------------------------------11------------- <br /> --------I---------------- -------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------- <br /> -------------- - ---------- Permit Expires I Year From Date <br /> ---------------- (Complete in Duplicate) <br /> - _ I This P Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora 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...... V <br /> . ........ ' <br /> .tV <br /> Owner's Name------ _----6.g�>-_Claw ................. <br /> Address................... T° <br /> ---------------------------------- ------------------------------------ Phone../?.* <br /> ---------------------------------------------------------------------------------------------------------- ....................................... <br /> Contractor's Name. ge <br /> 1K_--SCW---------14,01C t-&#------ ... Phone.isr ....._?........ 7 <br /> Installation will serve: Residence El Apartment House [] Commercial it Trailer Court [I Motel 0 Other <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size <br /> Water Supply: Public system E] Community system E] Private W Depth TO Water'Table ft. <br /> ,,, J-4 <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel [] Sandy Loam E] Clay Loam 0 Clay [] Adobe 0 Hardpan 0 <br /> Previous Application Made: (If yes,date--._____-______-) No 01 New Construction: Yes NJ No [] FHA/VA: Yes E] No)? <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_ $C_1------Distance from foundation____4O---------Material----- <br /> DO No. of compartments---------;k------------Size-;.r-X - <br /> ---------Liquid depth___.-_V.-------------Capacity....P7P_ <br /> 411 <br /> Disposal Field: Distance from nearest well.JW....Distance from founclation.-A-40..........Distance to nearest lot line---�9!kl <br /> PC Number of lines__- A --- -Length of each line----- -'-------------Width of trench-----4_9 <br /> Type of filter material.J. " A0 <br /> A---------- Depth of filter material-----j!Ra----------Total length.--------/;?4?---------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line...___...._...... <br /> n Number of pits-------- -------------Lining material------------------._-Size: Diameter-----------------_ ---Depth--------------------------------- <br /> Cesspool: Distance from nearest well--------------_-Distance from foundation--------------------Lining material..... ------------------------------- <br /> 171 Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity------------_-------------gals. <br /> Privy: Distance from nearest well__.___-________-___________---_-_____ Distance from nearest building------------------------------------------ <br /> 171 Distance to nearest lot line-------- <br /> Remodeling and/or repairing (describe):--- e0----ri -------r,+Iv--h--------- ......Ll"--e--------To.............5' Y.--e e- <br /> ----------000MI-->---------PA4.-CIA---i-IV-7--------57A-P,,-d----------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> (Signed)-------- --------------------f-----------S----(0r_.3r,1---------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:------------ --- ----- .... (Title)------ A <br /> --- <br /> ---- ------------------------------------------------------------ _1 4- ------ -------- <br /> (Plot plan, showing size of lot, location m in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED�BYY---------- <br /> REVIE0 VIr r:, ----------------------------------------------- DATE------- <br /> _W ----------------- <br /> WED BY--------------------------------- ------------------------------------------------------------------------------------------ DATE <br /> BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------ DATE <br /> Alterations and/or recommendations: <br /> ----------------------------------------I-----------------------------------------------_-------------------------------------------------------------------------------------------------------------...................... <br /> ---------------------------------------------------------------------------------------------------------------1-1----------- --------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------- --------------------------- --------------------------------------------------------------------------------------------------------- <br /> --------­----- --------------- --------- - --­--­---­------------- ------ -------- <br /> ------------------------------------- <br /> --------------- -------------- <br /> FINAL INSPECTION BY:--------- ------------------------------------------------------ --- <br /> ------- ------­--------­-- Date--------------- /--- <br /> SAN <br /> ate--------------- <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 />