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APPLICATION FOR SANITATION PERMIT Permit No. Z .7--.9-0 <br /> (Complete in Duplicate) 6� <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei ascribed. <br /> This application is made in compliance ith County rd' ce No. 549. x/ <br /> JOB ADDRESS AND "AT •••-- <br /> II// // //-- <br /> Owner's Name_____________ <br /> Q �.r� C1_c •/ ••------ ----------------------- Phone../xf'�--' -J,2� O <br /> Address--------------------------------------- -/_ <br /> Contractor's Name Q - 47`�/------------------------------------------------------------------••---- Phone-�-�--`��'------`-- <br /> Installation will serve: Residence PO'—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _./___ Number of bedrooms __�_a Number of baths J_.__ Lot size --------S0-----X_1SSCJ--------------------- <br /> Water Supply: Public system 0KCommunity system ❑ Private ❑ Depth to Water Tables�_� _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ eHardpan ❑ <br /> Previous Application Made: Yes ❑ No [t'`Iew Construction: Yes No ❑ FHA/VA: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest well____...___ Distance from foundation---X1.0._!--___--Mater�l--- ---------------- --- <br /> - No. of compartments_.PFR!vw_ O—�__o�--_Size_,,�6__X---f _0__.___Liquid depth------ /�_----_Capacity..?................ <br /> Disposal F' Distance from nearest well----.r-----Distance from foundation-,10. Distance to nearest lot lineaS_!___••-•- <br /> Number of lines......___/_------------------------Length of each line-------- <br /> Width of trench__ y��______.__.______.__ <br /> Type of filter material_ QG.1<-__--_-_.Depth of filter materialjS--_�_________ <br /> Y' Total length-------- 0 -- <br /> _ -. ______________________ p� <br /> Seepage P' . Distance to nearest well------'-.__Distance from foundation__/p............Distance to nearest lot line-----+ _L.-Number of pits------)--------------Lining material-_- —-----Size: Diameter._. 3_____._.__Depth_....s;-Is_-/-__._-----____-- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------•_--_-__-._-_-_-.._____-_ <br /> ❑ Size: Diameter----•---------------------------------Depth--- ------------------------------------------------Liquid Capacity---•-------------------_---gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--__----_-.__.-____-.____-_-_---_.-_-_--_. <br /> ❑ Distance to nearest lot line------ -------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe): ------ -----' ------"-----------•---------••-••--------------------------------------- <br /> ..••----•-•-•'-•••••--'-•---------------------------------------------------------- ------------------------------------------------------------------------------------------------ ----------------------------• <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------z----------------------------------------------------------------------- <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 /> ordinances, State laws, and rules and regulationAffin n Joaquin Local H alth District. <br /> (Signed)------41oction <br /> -- - --- -- --- ------ - � �--=�'-�------- ----(Owner and/or Contractor) <br /> By:•-••--'-----'•••"--''-•... --------------- - ---------------(Title) ------ -- - ---- - - <br /> -------------- <br /> (Plot plan, showing si loof system in relation to wells, b ' tc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> REVIEWED BN--ACCEPTED BY-----------------------------------------Lr <br /> -----------h`���"r_�!yf�•:.'------------------------------------------- DATE------- l#�------------------------------ <br /> - - ------------------------- DATE•-•--_ ---------- ---------- <br /> ------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------.........--------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:..- -----------•--------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------- <br /> FINAL INSPECTION BY:•-�--=-- --� ?�L Date 15-- 1�' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 8-'59 F.P.Co. <br />