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FOR OFF,iCE SE: <br /> - --- ------- ----- ----- - Permit <br /> No. <br /> APPLICATION FOR ,SANITATION PERMIT <br /> --------------------- (Complete in Duplicate) Date Issued <br /> ------------ ------ This Permit Expires 1 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. 549. 11 <br /> JOB ADDRESS AND LOCATION---•-- �- ---- <br /> r <br /> - <br /> /p ` ---- Phone.--•. -••--. � <br /> Owners Name------------- _.�.��. l..III C� ---------------------------------1. <br /> - <br /> ------ Phone <br /> Address------------ � 1 � <br /> Phone <br /> Contractor's Name_-. _-.. __ <br /> Installation will serve: Residence� Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___.{ N I bar of bedrooms _Number of baths ----- Lot sized ,1--- r7e -�- z'lr___..._ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table <br /> -eft. <br /> of 3 feet Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Character of soil to a depth ❑ <br /> Previous Application Made: {If yes,date-----------------_-) No [INew Construction: Yes Q No�FHA/VA: Yes E] No [I �I <br /> TYPE OF-INSTALLATION AND SPECIFICATIONS: l <br /> (No septic tank or cesspool permitted if public ewer is available within 200 fee+.), <br /> I Distan from f u dation--.. 0...-----_.Material-.-----.Q1+�---------- W <br /> Septic T k: Distance from nearest w II- _.-__ �1 (� <br /> --------- - <br /> j ly <br /> No. of compartments __./�-------- ------Size-- - --.-------Liquid depth------ f°____.-Capacity... !>� _-- <br /> ry en <br /> �Disposai laid: Distance from nearest well-- Q1I Distance rom oundation..___, Q----..Distance to nearest I t lin <br /> x- <br /> Length of each line-.----. - Q-�-.e�.....Width of #ranch.---_- _ __ f-------•-� <br /> Number of lines___._-+-_ g ,r°� <br /> Type of filter materia_ca PL�-Depth of filter material---�g._---�,_.Total leng}h___.______..._J`T ©-----6�/ <br /> 1 ..-D:_---•.Distance to nearest lot line._:_--._-_---.. <br /> Seepage #: Distance to nearest well�_c'_�_lQ___--Distance from foundation f� <br /> Number of pits----_I-------.-------Lining material--RQ. --c,----Size: Diameter-_.-: <br /> --� Depth-------2i ;:... <br /> Cestspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material------------------------ <br /> -els. <br /> �" r <br /> Size: Diameter--------------------- ----------------Depth.---------------------------------------------------Liquid Capacity--------•------------••----g <br /> Privy:', ar <br /> Distance from neest well------- --------------------------------------- <br /> _ <br /> -Distance from nearest building- ___.__-._______--_---....-----•--___-•• <br /> ❑ Y ----- <br /> s Distance to nearest lot line ------------- <br /> v t <br /> Remodeling and/or repairing (describe):- '7 �'f-� ' 1 '�.�L - _-.1 " ------•--- <br /> i ---------------------------------------------------•------------------------ <br /> -------------------------------------------------------------- ----•--------------------------------------------------------I------------­­­------------------------- <br /> ------------------------ --------------------------•----------•------------------------------- <br /> ------- - -----------------•-•-- = ----------•- . <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, ate s, and rules and regulations of the San Joaquin Local Health District. <br /> C (Signed) � j�` ' R �� 1 Cy . -urn st —S-- C.-A--------------------- <br /> --(Oor Contractor) <br /> - Title ----------------------------------------- ------- <br /> By:---------------•-------------------------_--------------------------------------- f -•✓ ( ) <br /> (Plat plan, showing size of lot, location of system in rela+io to wells, buildin , etc., can be laced on reverse side). Y <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED $Y-------•' -------------------------•- <br /> I ------•---------------- DATE------ = � -7------------------------ <br /> -- �-r--7=�-�'=-�`J ----- <br /> REVIEWED BY-------------------------------------------- ---------------------------------------•----- <br /> --------------- DATE----------------------------------------------•------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------ ------- DATE <br /> Alterations and/or recommendations:----_ - - ----' -- <br /> -------------------- <br /> '7�/2 --�+' ----------•---- gkc------------�'- ---•--------•------------------------------------------••----------------•- <br /> 11-:1 <br /> FINAL INSPECTION BY:....... - �� Date ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> dt <br /> 130 South American Street.- 300 West Oak Street 124 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />