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rUK UFFICE U5E: <br /> t- <br /> ____ ________ rr• <br /> APPLICATION FnR SANITATION PERMIT `Permit 1Vo. .. ..��t T7 <br /> -------------- _ (Complete in Duplicate) <br /> ----- --- - -- -'------------ This Permit Expires. 1 Year From Date Issued <br /> Date Issued ..... � .. .� <br /> - "-----� --' --�- <br /> Application is hereby made to fhe San Joaquin Local Health District for a permit to constru,t nd install he wprk herein described. <br /> This application is made in complianc .4,-.1 <br /> e with County Ordinance No. 549. :1����/ <br /> 16o 7 Z_ CA) <br /> • B o cv.,, <br /> JOB ADDRESS AND LOCATION------... - ----- --------------------- - <br /> Owner's <br />` Name---•--•-"-.-=• ^.•��- - -x-.. - <br /> : J <br /> ..---- - . - -----/-•--'l--/--- 2•S---u--- y <br /> Phone.Address --�------ <br /> X7 <br /> --------- <br /> .................••--••-------------••--.............................................. <br /> Contractor's Name............... . --. ------------- -- -----I-------------------------------------- .................... Phone_.. A-: --, <br /> Installation will serve: R ante El Apartment House mmercial ❑ Trailer Court ❑ Motel ❑ Other [' <br /> Number of living unit9:-W-- Number of bedrooms ..------ Number of baths -------- Lot size -----2__-�10.`��_--.-�.--��-_, <br /> Water Supply: Publics stem <br /> y E] Community system ❑ Private, ] Depth to Water Table 1-.'�'ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel_.[] Sandy Loam Nr Clay Loam ❑ Clay[2 Adobe[:] Hardpan ❑ <br /> !�- t <br /> _ Previous ApplicatioriM <br /> , adei(If yes date_______ ___________) No a New Construction: Yes [j No ❑ FHA/VA: Yes ❑ Nps] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer' is available within 200 feet.) <br /> Septic Tank: iDistance from nearest we'11 _40 -!__.__Distance from foundati � <br /> .. Material <br /> r� ...........:........................... ....... <br /> ® No. of compartments ' Size-1 �`-1��X `r... squid depth------....$1- --•'----...._capacity <br /> Disposal Field: distance-from-nearest .well__.__:- Distance from foundation------,V.4!......Distance to nearest lot line........Z.-cam } <br /> f[3 Number of lines---------------2.� S-----------Length of each line...........e, s........Width of trench--------- 3 <br /> Type of filter material._ <br /> YP =---Depth of filter material-- -------• -Total length---.--- - ------- <br /> ----------- <br /> Seepage Pit: Dis#ce to nearest well------------------ from foundation:-,.._._._._.__...Distance to nearest lot line__._--._-__•_---_ <br /> �. P g•material------•---------------Size: Diameter-.------------- Depth_ ' <br /> ❑ Number: of its-------__ ___•-•___-.-Linin <br /> Cesspool: Distancefrorn nearest well _..- - .D.isf�ce from foundation.................... .Lining material------------------------------------- <br /> T- <br /> ..______________________ i <br /> ❑ Size Diameter.t Depth__...` :- --• ------------------------Liquid Capacity ........gals. <br /> Privy: Distance from nearest well____._.____"__________ �_� __-- Distance {rem-nearest uildin <br /> 1 �_ . L , tt _ 9 -•--------- <br /> ❑ Distance to n6arest lot line_ •s} --- "—` %" <br /> _ -------------•---•--------- =...................................----"------ --------""---------•- <br /> Remodeling-and/or repairing [describe):_-_____- "{_•- �-_--_----. � ' . __ <br /> -------- _ <br /> =- -ne <br /> Kir F <br /> ----------=---- - r`�d7` � •G n I�_ -_ --- <br /> !"hereby certify that I have prepared this application and that the worwill,be done in a cordance with San J aquin County <br /> ordinances, State I ws, d rules and regulations of the San Joaquin Local Health`District. e,e _ ����, <br /> (Signed)-__--_-.'.__ <br /> o.... --------------------------------- <br /> 1 \:.--------'------------------------(Owner aridJor Contractor) <br /> BY- `--•-- ---- - - ••------------------------=--------•--=--------------•-•------(Tit i <br /> (Plot plan, owin ,siz�f lot, locati of system in relation to wells, -buildings, efe., can be placed on reverse side).;. <br /> FOR DEPARTMENT USE ONLY r <br /> APPLICATION ACCEPTED BY -------------------- DATE......' <br /> -- ---f=VIEWED BY .. <br /> -------------------------- <br /> ---------------------- <br /> '------------------------------- ------------------------------_--- <br /> � - DATE.­----------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------ ---------...--------------- DATE_---------- -- <br /> -_Alterat' ns a d/or recommendations------------------- ------ <br /> -•-"_ _4 <br /> - /.G__._-�.!!-_-'_'..r•- <br /> ---'•-''-:--�¢-..a- fR..�'..�� ' � <br /> / �- •--- � -_----.-- --- V•-------r-----•--•- -------- ---- - <br /> 4 - . -- -..' <br /> ----------------- <br /> -------�-- <br /> --C <br /> ---------- <br /> --------------------------------- <br /> -----_- f2,_*�=-Zex------ ---� __Q ' <br /> ....-'----••--' <br /> S <br /> FINAL INSPECTION BY:----------- _._._ V4,104-r, c3�[� <br /> - Date------------------- .. I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stri.:t 300 WestOak-Sir"# - 124 Sycamore Sfnoi <br /> 205 Wast 9th Street <br /> Stockton;California Lodi,CafiFornio Manteca,California <br /> �- <br /> E6 9 REVISED 5-59 2M 6-61 AILAy �� � � - Tracy,California a/ <br /> f <br />