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FOR OFFICE USE: t <br />_..__.-__.._.._--_-____--_-_-_-..-._-_---_-__._._. APPLICATION FOR SANITATION PERMIT Permit No. ..�.z�Ql__... <br /> --- -- --- -- --- (Complete in Duplicate) Date Issued .__.y/�/._.�.b/�- <br /> ----_ .-.-.. -.--. _ ----.-.- This Permit Expires 1 Year From Date Issued <br /> __.. ..__ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h rein described. <br /> This application is made in compliance with County Ordinance No. 549. M PINYEZ8 <br /> JOB ADDRESS A .AIRPORT D LOCATION._.. .....RD. ... 2. ------RACE---. <br /> 0 �ATHRo <br /> Owner's Name------- ---- a� ------------- ------------ hoge ---- <br /> ..............•. <br /> Address----•-.R E--'---_5._....-..bQ-�---------5-5—--------MAN-Tvcp..................................................................................... <br /> Contractor's Name---------IVIgR:TI-1.4.------.. RT-------------------------------------------------------------- Phone.................................. <br /> Installation will serve: Residence e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _�____ Number of bedrooms .� Number of baths ---- Lot Lot size _ -R�.. ::� .................. <br /> Water Supply: Public system ElCommunity system ❑ Private[Depth To Wgter Table'1�. ft. <br /> Character of soil to a depth of 3 feet: Sand eGravel ❑ Sa dy Loam E] CIayLoa [jClay Ado5e[�] #iardpen [IPrevious Application Made: (If yes,date-..-----_____._) No New Construction: Yes la ❑ FHA/VA: Yes+❑ No <br /> TYPE OF INSTALLATION AND-SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 20p feet) ; <br /> Septic nk: Distance from nearest well_- --------Dist3ace from foundation_-_! .__....Material-. 40mG ��� . <br /> No. of compartments--- �--------- ----Size_J.x_-'?_.x_---.77...Liquide�th-----� y-----Capacit�---1,Z..�.�.. o <br /> Disposal Field: Distance from nearest well Jr— _Distance from foundatioa....�.+�c .._...Distance to nearest to line___.. <br /> Number of lines______.____l77�� Length of each line-------C?Q:-?�__. Width of trench._..... .. _..��................ <br /> Type of filter material.-. ..__Depth of filter material-__._f ----_..Total length............ <br /> ..................... <br /> Seepage,Pit: Distance to nearest well -.--_Distance from foundation....................Distance to nearest lotline................. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter- Dept #------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---_.------- --_-.Lining material----------------------­---------- <br /> El <br /> ------______-_-__-.---- <br /> ❑ Size: Diameter--------------------------- ------Depth-------- ------------------•---- -------------------Liquid Capacity---------- ..............gals. <br /> Privy: 'Distance from nearest well ...._ .. .._ --. Distance from nearest bulldmg .....................� <br /> ❑ Distance to nearest lot line - -------- ---- - -------------------- ------------- ---- ---------- •- --------------- �. <br /> Remodelingand/or repairing (describe):----- --------------•----------- -----------------------------------------------------------------------------------------------•-----•---•-------•-•-- <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 /> (Signed) 614 ....................:......® -----------------------------------------------------------•-------------------(Owner and/or Contractor) <br /> By:--------------------------------------------------------- -------------------------------------------------------------------------(Title)------------------------------------ <br /> ------------ --- -- ---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY s <br /> APPLICATION ACCEPTED BY--.-- ------------------------------------------------------­--------- DATE------jJ _-l3_`__6.2............------. <br /> REVIEWED, BY--------------------------------------------- ------------------------------------------------------------------------------ DATE............................................................ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:------- -------------- ------- ---•-----._....-----•---•----------------•-------•--•---------•-----------•------•--••-......---•---•--•-•----- <br /> -•----•--•--------•--------------------•-•--=............•-------•- ...... ------------•------•- -------- ..............---------••...------------.............-------••-•---••••-------•-•••--••••---•--...----••-••-••-- <br /> --•-•----•---••-----------•-------------------•------------•--••---- ---- ----------- --------------------------------•-•----....-----•---•-•---...........------•-------••---•-••------...----•-•----------••----•-••---•-•-- <br /> -----•---------------------•------•----•----- ...... - ----------------------- ----- ------------------•------•--••--------•------•---------••------•-----•-•-•-••----------.....••---......... <br /> FINAL INSPECTI -� - Date------_--- 1../.:' r�- ..... <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 8-59 2M 5.62 ATLAS <br />