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FCO OFFICE se _ <br /> ------ -`--- - -- --------- .------ .- APPLICATION FOR SANITATION PERMIT Permit No. .•..1.....�. .5 <br /> ---------. (Complete in Duplicate) / <br /> �/.�-��-J� Date Issued ._.7. w- <br />-----------------1 ._-_____--_.___.___ 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 /> 4S <br /> JOB ADDRESS AND LOCATION--------FO_.--------- Ld� ���I----------- "' ` 'SII -------••---------------•------•-•----- <br /> Owner's -----------ii?-�•-------��--_19-,t-------•-------------------------------------•----------------------------------- Phone-6. Z.- -•� <br /> _.�G;l �t <br /> Address........... �`2/_ l� hr�1G/ 1�J '.gl._. ----------------------`��' = <br /> -----------------•----•-------•------- <br /> Contractor's Name-------- `1�= .��.�. f7�. -LS�Q ` '--------/.w ---------•-•--------------- Phone..�y0. ��`7---- <br /> Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .-`___ Number of bedrooms __ -Number of baths J---- Lot size ...... ---------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private a Depth to Water Table AZ_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ -Gravel ❑ Sandy Loam ❑ `Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date------_-------------} No 0 New.Construction: Yes ❑ No e FHA/VA: Yes ❑ 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_________________Distance from foundation------------------..Material------------------............................... <br /> ❑ No. of compartments ------------------------Size..............-------------------Liquid depth- ••----------------_-Capacity--------•--•-----•---•- <br /> Disposal Field: Distance from nearest-well-----------------Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of lines-----------------------------------Length of each line-----------•------------------Width of trench----------------------------------- <br /> Type of filter material .-----Depth of filter material-----------------------Total length.-.-....-------------.-----------------.._ <br /> Seepage Pit: Distance to nearest well-----_----------------Distance from foundation__--_fes.......Distance to nearest lot line._..-j_.... <br /> b - r <br /> gf lgcfd Number of pits--------/.___..-_-__Lining material __.Size: Diameter------$I&_.........Depth----------/�"_______________ <br /> Cesspool: Distance from nearest well_________________Distance'from foundation----_--------------.Lining material--__.__--_-__-_____......._.__.____- <br /> ❑ Size: Diameter--------•-----------------------------Depth--:-------------------------------------------------Liquid Capacity---------------------------- <br /> Privy: Distance from nearest well------------------------------!�n---------------Distance from nearest building------..._..________-_-.--.---.-_.._-____. R <br /> ❑ Distance to nearest lot line--------- --------------•--------------------------------•-•-----------------•-•--•---------`----------•----------------..-------------•--- <br /> Remodeling and/or repairing (describe):-------/3WR1------ r�6�7_7_.,V.G----------- / %!�°--------$_f'.�SJ" -r-.-.-.._--••--•-•-- <br /> 1 <br /> --------------•-----•---------------••--•-•--------------•---..-----------.--....---.......-----------•----------------- <br /> h <br /> ------------------------------------------------------------ ------------------------------------------------------I----------------------------------------------------------------------------------------------- <br /> ___________________________________________ _________________________________________________________________________________________________________________________________________________________________________ <br /> hereby certify +hat I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. <br /> i <br /> (Signed) !` fl--.-- c Q/L�.�------------CNG" = (Owner and/or Contractor) <br /> BY: 4-------��---�'-- ` 4 (Title) 4xS <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY.--- — ------------------------ ------------------------------ DATE---- -------------------------- <br /> REVIEWEDBY.---------------------------------------- ---------------------------------------•------------ DATE---------------------------------------------------- <br /> ' BUILDING PERMIT ISSUED-------------------------------------------------------------- ----------------------- -----------. DATE--------•-•--=j-------------------------------- / <br /> Altera+i1ons and/or recomm��enda+ions:-__ .-_I_-..�2 ? ------ ------ c ,� LA.---- - Q - --L ....... <br /> a.�' ✓ <br /> �.................. .;...._.______..____..____-______________.__-._____________------__-_______.._.._____.__________________.__..._...._.._______-..___._.__...__..-._.._._...______.... <br /> ___._-----._`_---______________------------------------------------------____-------------------_-----------------------------_---------------------------------------------_--------------------------------------------------- <br /> -------------\L----------------------------------------.-_.__.------------------------------------..---------------------------------------------------------------.-------------------------------------- <br /> ......- <br /> 1 _____________VVV..___.._--_._.____-.....__..........----------------------.---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 7 <br /> FINALINSPECTION BY:.---..0'........6C_&_q_S-------------_---------------- ------------------ -------••------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strout <br /> Stockton,California I-ocil,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 ZM 5-61 ATLAS <br />