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FOR OFFIC UST- <br /> SANITATION PE <br /> ^------�-� -------1 � PERMIT <br /> Permit No. _.......�.•_.._..... <br /> _ �3d APPLICATION FOR SA <br /> --------------- - <br /> ---------------- ----- - (Complete in Duplicate) - =`Date issued ----•--• - <br /> I--- -- --- ------ <br /> ---_-_----------------""" This Permit Expires 1I 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. S49. <br /> JOB ADDRESS AND LOCATION---------•(7:3--6-----------s�---•---- A'1 . _"-T_�---------- ---------•------- <br /> Phone-/7'0_Y-f__ry <br /> Owner's Name-------- -..............11:�1�.FL"�_---------------------------- <br /> Address---------------- nF_IEP_OZV_ <br /> S`S I-T!yt C --••-----------•----------------- <br /> Phone_ 6.1.6-07-. <br /> + Contractor's Name_----{�= fa= ��11�_�-l.•��'} �' -------.•!/V- <br /> Installation will serve: Residence 1ZApartment House ❑ Commercial ❑ TrailCourt ourt ❑ Motel ❑ Other El <br /> 6 f Z?.'. <br /> Number of living units: __j..__ Number of bedrooms --ZNumber of baths _..)- Lot size __-.----..2______ ......______ <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth To WaterTable •--ZQ f+• <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [ISandy Loam❑ Ciay4Loalm E5'�oClay ❑ Adobe FHA/VA: Hardpan ❑ <br /> ❑ No <br /> Previous Application.Made: (if yes,date-."-_.--"---__.----) No E3 t <br /> New Construction:IYes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted if public sewer is available within 2b4 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--"""".-."--"------"-----•---••------------------ <br /> } " No. of compartments--------------------------Size--------------------------------Liquid <br /> --- ---•- ---------Size--------------------------------Liquid depth--------------------------Capacity---•----------------- <br /> ❑ ;a <br /> Disposal Field: Distance from nearest well""/I[Q -_Distance from foundation_----L '- ...__.Distance to nearest lot line..__�5.-_--.._. <br /> ® ,y„G <br /> ' -��- ----------Width of trench.......... <br /> Number of lines............I-------------------•-Length of each line---_----- �• �-;----------.. <br /> Type of filter material._;20�_k---"___--.Depth of filter material._-"1_�'�___._---Total length_.r..............�'�_--__----------­ <br /> Type <br /> �_1__.... . <br /> Seepage Pit Distance to nearest well__ -------Distance from foundatidn-_.-/Q--�._--__.Distance to nearest lot line--- _"---.__-.. <br /> Number of pits--------- ------------Lining material:-'ez /�-------Size: Diameter...... _ ----..Depth-----•-----•--- - = <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------.------.Lining material-------------------------------- <br /> --.-_----"Li Liquid Capacity gals. <br /> ❑ Size: Diameter-------------------_--- <br /> Depth q P tY <br /> Privy: Distance from nearest well-----------------------------------------------------------<;-----Distance from nearest building-------------------------------•--------- <br /> ---------------- <br /> Distance to nearest lotline____.-"_____________---------------------------------- ------------------------------------------------•-•--------- --•-----------------"------------•----- <br /> - <br /> Remodeling and/or repairing (describe):------- ------ "° ` `-" ------------------ --------------------- <br /> -------------- <br /> ----- --- - ------ --- -- - - ------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - <br /> (Signed)------------0-'-�..- i - <br /> --.-.(Owner and/or Contractor{ <br /> - ------------------------------ <br /> ••--------------------•--{Titl <br /> (Plot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- -,..._ ------------------------ DATE.. <br /> REVIEWED BY <br /> �3 <br /> ---------- <br /> DATE-----------.-------------------••--•-------••-------------- <br /> ------------ DATE----------- --------•----- <br /> BUILDING PERMIT ISSUED--------------------------- • -------------------�------------•--------...-------- �l`�------------- <br /> ------- <br /> -•------------ <br /> Alterations and/qr,r eo mendations:"-.__ `�' "`" 'j` J � <br /> -- <br /> th �. ----------------------------------------------- <br /> --- <br /> v- <br /> -----------------------------------------.---------------------------------------------------------------- -----•-•• - <br /> FINAL INSPECTION BY:.---.------ --- -------rSAN <br /> Date <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> 300 West Oak Street 144 sycamore Street 405 Wast 9!fi Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 5-59 EM 5-62 ATLAS <br />