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FOR OFFICE USE: <br /> - -------------------- <br /> ---------------- <br /> APPLICATION FOR SANITATION Permit No. <br /> T <br /> (Cc 'plete in Duplicate) <br /> - ---------------------- -- - - - ---------------.. .............. This it ..... <br /> Date Issued .0. <br /> 1 Year From Date Issued -- I ory-0-:9 <br /> Application is hereby made to the San Joaquin Local HeA,11h District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordin6nce No. 549. <br /> iit7g&Y A)-' <br /> JOB ADI)RESS'-AND'L'OCATILN.J..,lt4&ltt.�2,,'-.`6i!.��,16�15 <br /> J,j t, <br /> 1 ! ---I It -- <br /> !-A, Phone--------•----------_------------ <br /> Owner's Name....1410�. z....f�j --------_-------------­--- --------------------------------- <br /> ............. rL. <br /> ZU "e <br /> -/�, _1*6 "I---------ag <br /> L_0.�.... .. .. !�_ . �_7� ._. _Z . ......1�_.......................................................... <br /> Address-------- -------?2 <br /> 4_ ---_---------- Phone. <br /> ............ <br /> Contractor's Name......610�7 ------ <br /> ---------- Apartment Court 0 Motel [3 Other El <br /> f'Zi ' Residence Installation will serve: ,idence Ap me House:E] Commercial E3 Trailer <br /> Number of living units: _j___ Number of bedrooms'3... Number of baths --/-- Lot size ----------------------------------------- ------------------_1Z1 <br /> Water Supply. Public system <br /> Community system ED Private 0 Depth To Water Table -------- ft. <br /> 0 <br /> Character of soil to a depth of 3 fee+: Sand I-] Grave1i,[] Sandy Loom 0 Clay Loam [3 Clay [] Adobe [I Hardpan Q <br /> Previous Application Made: (if yes,date------------- Jfl No New Construction: Yes E] No C] FHA/VA. Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I Z <br /> (No septic tank or cesspool permitted if public se'Wer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------j I Distance from foundation----------------_Material------------------------------------------------- <br /> ElNo. of compartments-----------= --------------------------------Liquid depth--------------------------Capacity-----------------` <br /> 7!;� <br /> Disposd Field. Distance from nearest well.__-26---------- )istance from founclatio __Distance to nearest lot line----- _--- <br /> ---------Width of trench___'�J-------------- ------------ <br /> Number of lines.------------- --------Length of each line-------749--- <br /> --- )epfh of filter m -------- ---- --------------------------- <br /> Type of filter material.'.* material—___ Total length --I I" I <br /> Distance to nearest well---- ad).......'bistance from foundation-._/P----/..Distance to nearest lot line--a,5-. <br /> Number of pits-------2—-----_Lining material. --------------------- <br /> _Dkwm*e Depth-_J7 <br /> Cesspool: Distance from nearest well___.________--([Distancefrom foundation--------------------Lining material--------------I---------------------- <br /> belpffi....f --------------Liquid Capacity_--------------------------gals. <br /> F1 Size: Diameter---------------------------- --------- -- - ------------------------- <br /> I .-Distance-from nearest building------------------------------------------ <br /> Privy: Distance from nearest well------------------------- .............. <br /> j 7 <br /> Distance to nearest lot line_______________ _i__ --_� <br /> -•--- •----------- <br /> - ----------❑Remodeling and/or repairing (describe):----------------------------�------- ------------------I—,-----------------------I-­-­-----------------------I---------------------- <br /> ....................----------_----------------------------------------------­--------1_1.............. ------------------------------------------------------------------I---------------------------------------- <br /> -------------­--------I—--------------------­-------------- ------------------------------------------------......�­_­--—------------------------------------------------------- <br /> ------------------------ .. ................................------------------------- --------------------- <br /> ------------------------------------- ----­---------------I------------------------------ ------------ ----------------------- ..... <br /> I hereby certify that I have prepared-ihis. application and that'the work will be done.in accordance with San Joaquin County <br /> ordinances, S a laws, and rul s and,-regplations;of Ad'San Joaq4in Local Health District.." <br /> V <br /> ----------------------- ----- <br /> (Signed)-.. ------ ---- ----- - -- ------- ----- - :t_40W9FTRa7or Contractor] <br /> ------ ---- ---- --- PI Q------------------------------------------(Tif le)_� <br /> (Plot plan, showing size of lot, location of systemi rel�a iowt <br /> lo wells, buildings, etc., can be aced on reverse side). <br /> FOR 6,EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ ------- ------------------------------------------------------ DATE---- ---------------------------------- <br /> REVIEWEDBY----------•---------------------------------- ------------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED--------- ---------------------- M--------------------.....-------------------------•._ DATE------------------------------------------------------------- <br /> -- ---------- <br /> Alterations and/or recommencratio'n's:-------------------- ------:------------------------------------------------------------------------_._---------------------------------------- <br /> -1-----------------------------------------------------I---I------------------------------- -----------------------------------------------------------------------I—....­----------------------------- ------------- <br /> .............-------------------------------------------------------------- ---------------- ------ ------------------------------------- ------------------------------------ -----------------------------------....... <br /> ----------------------_-_-----------------------------------•1-----------------------------I---------------------------------------------------------------------------------------------­------------------------------- <br /> -------------------------------- ------------------------------------ --- ------------------- -------------------- ------- ----------- --­------------------ ----------------------- ----------------------------- <br /> FINAL INSPECTION BY:----- I- -------------- -- ------------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American$front 300 West Oak Strill i 124 Sycamore Streqi! 205 West 91h Street <br /> Stockton,California Lodi,California r Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5.62 ATLAS <br />