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FOR OFFICE USE; <br /> -------------------------------------------------- ------ <br /> --------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------ ----------- (Complete in Duplicate)—cate) <br /> Date Issued <br /> ------------- ----- -------------------------- <br /> ----------- This Permit Expires 1 Year F'r-orni6'ate Issued <br /> Application is hereby made to the.,San'Joaquin Local -He-'al+h Di'sif-rilct fola piermit to construct and install the work herein described: <br /> This application is made in compliain'cg with County Ordinance No. 549.. <br /> JOADDRESS AND LOCATION/--- 10-F----------3RD'---------W------OF_ <br /> al_q � 1 7 <br /> Owner's Name------Fkafj�;,' 6 , <br /> SC 0 --------------------------------------- Phone------------------------------------ <br /> Address.........R_TjE=J_­-.1!0_0_k liOT,�7 <br /> Contractor's --------------------------------------------1.4--------------------------------------------------- Phone----------------------------------- <br /> Installation will serve- Residence Apartment House E] Commercir6l [3 Trailer Court [:] Motel [-] Other [3 <br /> Number. of living units: -.I.__-4,-Nu nbet of bedrooms __j---- NumWbJir ! f b1ths I---- Lot size ...0 Z------V-----2--,QP----------------- <br /> Water Supply: Public system [:1 Community system h TO Water Table <br /> Private Q D.pi / ft. <br /> Character of soil to a depth of 3 feet: ,San d,gKG ravel [] Sandy Loam k0ay Loam [] Clay 0 Adobe E] Hardpan-15" <br /> Previous Application Made: (if yes,date_.. ---------) No Nei"Construction: Yes MR- No E] FHA/VA.-Yes C] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool,,permifted''if public'sewer'i's' available within 200 feef.y- <br /> Se nk: DistandelroO"m"'nearesf well----- -.-Distance from foundation---,/ --------vate ,ai R I,-D w-q olr>------ <br /> e 4 <br /> Pe _�,No. of compartrne,f�--,*;',--"r�.'7-------.--'S',Zii�-3��-)--(--1-7------)(-�-5-,----Liquid clep�h........ -,V-------,Cap6city__974_0... <br /> Dii�OoW Field: Distance from ne6rost well......5,01 Distance from foundation-----/..0-------Distance to 'nearest lot line----S7__ (A <br /> 7- <br /> Number of lines,- ------- c <br /> _ :__1---------------------IlLength of each' line------- Width of fren --- ------------------- <br /> Type of filter ma <br /> ------/9?_"____TotaI length........SIV------------------------- <br /> Seep : a Pit Distance to nearest}well ._-4--Dislance rom foundation--------------------Distance to nearest lot line----------------- <br /> Pg 1 0,, " �v I <br /> ❑ n - rn �ial----- <br /> Number of pits--------t-------------i�,6irg I mate_ ----- -----Size: Diameter-----------------------Depth---- ------------------------ <br /> Cesspool: Distance from nearest bistfatn"t4l4from foundation--------------------Lining material__._____--.--__._.___-_-......_...._. <br /> ❑ Size: Diameter------ Depth--------------- I----------------------------------Liquid Capacity...........-.............gals. <br /> I-------------------------- <br /> . - - 7777! <br /> Privy: Distance from nearest lMl------------------------------------ ---Distance from nearest building----------------------------------------- <br /> F1 Distance to nearest lot'line--- ------------------------------------------•---•------ ------- ------------------------------------------------------ <br /> Remodeling and/or repairing (describe):--------WFL-L-------A_l3_QV__T-—---------- ........4_Ijvl�>_/------- ........................ <br /> rA <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- f . CJ <br /> --------------- <br /> ------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------------------------------------------------------- <br /> ------------------------------ --------------------I——-----------------------------------------------------------------------------------------------------------------­1----------------------------------------------- <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)_!K�_ ----- ------------------------- -------_------------- ------- ---------.(Owner and/or Contractor) <br /> By:--------- <br /> ... ---------------------------------------------------------------------------------------------- ------ -—--------m ----�­_---------—7----------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildinqs, etc., can be placed on-reverse.side). <br /> FOR DEPARTMtNt USEi6.QY 'k <br /> APPLICATION ACCEPTED BY------ --r-, --------------------------------------------------------------------- DATE----- / 'r ¢ "' <br /> REVIEWED <br /> ATE------ <br /> REVIEWEDBY--_-----_----------------------------------------------------------- ----------------------------------------------------- DATE----- --------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-_---------- --------------------- --------------------------------------------------------------------------------------------------------------------- <br /> -------------------2........e-_l----------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -Ft7-(D,4 ----61 MA,.Pq <br /> ................ .. ._ <br /> _- .. ---------11 ------- <br /> �AR------------------------------ <br /> --------------------------------------------------------- ---- --------- <br /> ---------------- -- -----------------------------------------------------------------------------------------I------------------------ZA_co, <br /> rte <br /> ---- --- --- -- -- - -----------------------=­------ <br /> - ------------ ---------------------------------------------------- <br /> FINAL INS TION BY: Date---------/---------f- ----- ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> __ ,. ,�'I& <br /> 130 South American Street 300 West Oak Street 124 Sycamord'Str" 203 t West:9th Street <br /> A <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 21A 8-452 ATLAS <br />