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FOR'OFFICE USE: <br /> -= <br /> -------------___-------------------------------- A PLIC TION FOR SANITATION PERMIT Permit No. ..------ <br /> (Complete in Duplicate) �Fa . <br />--------------------------------.......................... This Permit Expires 1 Year From Date Issued <br /> 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. 549. <br /> JOB ADDRESS AND LOCATION-------I/-------------Lx----.- ----------------------------.......•..........---•-----•--..................... <br /> Owner's Name------......4.t... ...--e'-"0-4Y 2,0.S------------------------------------------------------------- --------------- <br /> Addresse! !?7 ..............-.......................--------------........................-.................................................................................... <br /> Contractor's Name----------- ........... Phone. . .. <br /> -e_..�J✓ PD /< f 7 cif/ �v._. <br /> Installation will serve: Residence E]"' Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ....I-_• Number of bedrooms -._"?--Number of baths ---I... L9t size ...el? X.__/-OV............................... <br /> Water Supply: Public system [v"Community system ❑ Private ❑ Depth To Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe 2'Hardpan ❑ <br /> Previous Application Made: (If yes,date----_---------__----) No O' New Construction: Yes 1Q"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 /> I ........................................ <br /> Septic Tank: Distance from nearest well__/IP,4c'�_Distance from foundation----/-0........._.Material._.__ ... <br /> 10 No. of compartments---------z______-------Size-_,5-� "-.-Liquid depth.......V......K.....Capacity...,e ...... <br /> Disposal Field: Distance from nearest well-Nd!✓:_Distance from foundation...._/_Ow_'......Distance to nearest lot line... ......... <br /> (� ---------------Len Length of each line_-_______- _. .._._..Width of trench------------2..�. S"Number of lines............../ g c,'F� <br /> Type of filter material._., �0�'-,,rC___-_.Depth of filter material.....lG.`----------Total length....................s-17-26.-`..--_..... <br /> Seepage Pit: Distance to nearest _._Distance from foundation___-- ...Distance to nearest lot line...!.5.......... <br /> Number of pits------./__------------Lining material-_- size: Diameter____-__s _.....Depth.........;?�.4 ............. <br /> Cesspool: Distance from nearest well_ ______________Distance from foundation..__ -------------Lining m"aimal--------------------------- <br /> -----------_--____--------_--_-.- <br /> ❑ Size: Diameter-------- -•- <br /> ---------------------------Depth----•-------------- -- - -----------•-Liquid Capacity----.....................---ga <br /> Privy: Distance from nearest well------------____________-----------------_-------Distance from nearest build ing------_______................. <br /> ..____...... <br /> ❑ Distance to nearest lot line-------------------------------------------•---- -------------------•--.............----------•-------•-----•----------•--•---------- <br /> Remodelinn and/or repairing (describe): C7 s� J -� rC?e.14KT <br /> --------------- '..........-...............................----------------------------------------------------------------------------------------------.....................-.................... <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 /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ( �9neSt / <br /> d)------------—---'-- _-- --....---:.......-----------•---- -----� �-... --=-------------------------------(Own and/or Contractor) <br /> By:. .......... ----- (riitle)---------- <br /> = .... = <br /> (Plot plan, showing size of lot, location of systemation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- <br /> 141­1V��--- - - - - DATE--------- ---:�l-K__'....----------------------- <br /> REVIEWEDBY------------------------------------ ---.-.------------------------------------------------------------------------------ DATE....................................................------- <br /> BUILDING PERMIT ISSUED........... ---------------------------------a--------................-..................... DATE..................... <br /> ...................................... <br /> 1.81 <br /> AFFerations nod�or-recommendations:._..__ u _.._ - ^- _t_a:, - ------- -=_�..�`1 .1.. .r .________.. <br /> -------•---- ---------- <br /> „ -c �'�.... --- <br /> Z ug T�-L: --- <br /> --------- -- - -------- <br /> ------- --- --------- - ---- - -------- <br /> '�------ �.? <br /> / ---------------------------------- <br /> FINAL INSPECTION BY:.... -------- ----- -------------- ---- Date------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 2M 5-62 ATLAS <br />