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'FOR OFFICE USI:: <br /> ..----- APPLICATION Fek `SANITATION PERMIT Permit No. ../ 73-71 <br /> --- -------- -------------------' <br /> t. <br /> - ----------------------- -- b-- (Complete'in Duplicate] _ 'Date issued -` - --- - <br /> ------------- 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 /> I This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION........-$03. )7__X•__Broadway_-(Sk4PA x)z..:--`r------------------------------- -------------- ----------- <br /> Owner';-Name <br /> ---------- <br /> Owner';-Name -ordri-K iQik ----------•-------------•---------- --------- ---------------------------------------- Phone-463 ------------- <br /> Address------------- -----------222.14-I+Wad.5Q_ ---Wh'y_----------------------- -------------------­------------------------------------------------------..'-.-------------------------------- <br /> i Contractor's Name n7 <br /> + Installation will serve: ;Residence a Apartment House [-]-.Commercial '❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> �. Number of living units: _-_2'- Number of bedrooms 1}__t4u-'rnber of baths ----2- Lot size -----_-V2-ACr1P---_------____________ <br /> Water Supply: PublicFsystem ❑ Community system ❑ Private ® Depth to Water Table .60- ft. <br /> 1 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑-Clay ❑ Adobe U. Hardpan ❑ <br /> Previous Application Made: (If yes date. "-- _ --.-____} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> m <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} , <br /> r [ <br /> Concrete Septic Tankg Distance from nearest well---1001----Distaice from foundation-----10 ......Material------------------------------------------------- <br /> I <br /> .- ---------------------- <br /> ---- <br /> t oNo. of compartments-----2--each......Size. ! If Liquid de h- <br /> fCapacity:___2 <br /> ' p undation_-_0---------Distance to nearest lot line-----.- } <br /> Dls osal Field: Distance from nearest weIL1Ql3-x __-.Distance from fo <br /> Type filter materia$ep ie__gk Len th of each line----99-- _.--------..Width of trench_ tl-._-_ <br /> Numbeerr of lines---•---�------------------- -- �-----_ <br /> ._-Depth of filter material------- 9...........Total length---------180x..(9QX---east) <br /> unit <br /> Seepage Pit: Distance to nearest well_1Mt-----= Distance fro m;foundation------10!------.Distance to nearest lot line----------------9j1 <br /> i Number of Pits_-.--2.-_------_--Lining material--._ ?4Ck'` -----Size: Diameter-------33.11 --- <br /> tt p t each <br /> -2 -------- <br /> - -h <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------_--------�-:-----. �) <br /> ❑ Size: Diameter Depth = -----------------------------_ --Liquid Capacity------------- -gals. <br /> Priv Distance from nearest well----------------------------------------1____--.-Distance from nearest buiidin # <br /> ❑ ,' Distance to nearest lot„line_�------ -------------- <br /> r --•-----------•----------••---------------- ----------------------------•------------------ -----Remodeling and/or repairing (describe):------------------------------------- <br /> ----------------•------------------------------------------ <br /> f <br /> ------------ •--••----------------------- <br /> 3 i < <br /> ------------------------------ ------------------ -------------------•---�------------------------------------------- ---------_-----------------�-----`-----------------------------------------'------- ' <br /> l <br /> I hereby certify that I have prepared +his application and that-fhe 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 /> t � . <br /> 1 (Signed) Tie DAY--&--I— - Septic_Tank -Serv�.ce-------'------- ---------- I---------------------------------------- <br /> By: <br /> --------------------« Contractor] <br /> IBY:-------------------------------------•--------... --------- -------------------------------------------------- -------------(Title)-------------------- ----------- ---------- - - -- --- <br /> (Plot plan, showing size of.lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). .. c . <br /> t FOR DEPARTMENT USE ONLY " <br /> APPLICATION ACCEPTED BY = '` -- ------------------ DATE.----- <br /> ---------------------- <br /> ---------- <br /> REVIEWED BY - �' -- DATE------- <br /> --------- - --- -' ' -------------- <br /> BUILDING PERMIT ISSUED------------------------------------- "" ------ DATE------------ -------------- <br /> �E <br /> _ L <br /> Al+erasions and ---reco--men ;tions:-------'-'.--�----------�-'-•--- .---- --�.-_------------- �-'-`�``"�---•-`-�'"�-----��--`ter------ -'�°-?. <br /> :,- <br /> ------------ rp <br /> ' <br /> ' n ------------------------------ ............... ---- <br /> ! - -'I111A i---------------------------------------------------------------------------------------------------------'---'---- ----- <br /> i FINAL INSPECTION BY:------•-- ---- -------•-------- -- Date----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hozelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> y E5 9 REVISED 8-59 3M 3-163 F.P.CD. <br />