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{ FOR OFFICEOSE- <br />---.----.. V-------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. l.._..__._.i�..... <br />--------------------------------------------------------- (Complete in Duplicate) <br /> ------------------------------ This Permit Ex ires Year From Date Issued Date Issued-1 ._.._. ._.._... ._&.v <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worl herein described. <br /> This application.is-made in compliance with County Ordinance No. 549. 414noelVeor pi" yVQjl lt�i*aa BRiA��' /" ✓ <br /> 4 JOB ADDRESS AND LOCATION..B..,?.__eQ,Y.,27.,T....._ Q !__"___ f/_f_._ !✓... ✓?Y.___,lsT_f1 €A_.Q!V__ ... '•Toe. <br /> Owner's Name-----.?C�',�4F....-•--111l.A_..A.-.a ------------------•-••-------•-•-------------------------------------------------------- Phone.,.l-1.0.1...I?9�2F_2 <br /> Address---------------jr.F'eg./17..-C.2----------------------------------------------------•--�•---•--••---•------------------------------------------•-•-•--••----•-•-•-•--------------------------•-----•--- <br /> Contractor's Name-----...D., :r' .--�rafz?tQ/t?�r .t ---- _ iY ......:1j1! '-................................... Phonal. iP.6 eP.7.. <br /> Installation will serve: Residence @ErApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ..f... Number of bedrooms __'--Number of baths --- ___ Lot size __'�..___.Fa� .'.QE----------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [s?"-Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam RrClay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date--------------- ----) No 21"' New Construction: Yes 3 "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 Tank: Distance from nearest well__' .....Distance from foundation----Z©_.........Material--- ............ <br /> C960$7"jW6 f No. ocompartments <br /> 4010p Size. �- Liquid depth 2 N Capacity... ._, ....... <br /> Disposal Field: Distance from nearest well..,41 .-'--Distance from foundation..-4(22------Distance to nearest lot line._Z�.�.. <br /> ®CXi6'f/fid Number of lines---_--------e-------------------Length of each line--------- .............Width of french-------S-'?. ................... <br /> nD Type of filter material._ .;FC>-_rr__/_4______Depth of filter material..../.d'----------Total length........ ___________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line__._____-__---.__ 1 <br /> ❑ �af+S?'INCa Number of pits.............. -------Lining material-----------------------Size: Diameter------------------------De pth----------------------....--------------------------------- <br /> Cesspool: Distance from nearest well.................Distance from foundation___.___--,_____.___.Lining material------------------------------------- <br /> F1Size: Diameter--------------------------------------Depth---------...----------------------------------------Liquid Capacity-- gals. <br /> Privy: Distance from nearest well________________________________ __Distance from nearest building <br /> ❑ Distance to nearest lot line_________________________________________ _______ ___ _ n-- — <br /> _r <br /> Remodeling and/or repairing (describe):_1 ;f}ti/-rC <br /> fJ7 ---_T __._ _ 4w�f'i 4 _ �!F! s____�.K-----_. <br /> ---------- �9 ht_. s!f.y.....4FN__!I;nf--- --------------------------------------•---•------------------------------------------------------- ....--------------- <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 /> � �✓ .Qi2r _ `f__.__ _.__ (Owner and/or Contractor <br /> (Signed)---------------`--------- �;P v— - '�- �_...__,.- I ) <br /> By:---------- 4�.�..... --- - --------- <br /> ----- ' --•-----------------------------------------•-(Title)•-•----Limit.-----=----------------------- -------------- i <br /> (Plot plan. showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> - ------ ---------•-----------------------------._..-------..._. DATE__A_-t_+G,2--------------------------- --. <br /> APPLICATION ACCEPTED BY--,,Io_ - --- - <br /> REVIEWEDBY-------------------------------•--_---•--- -------------------------------------------------------------------------------- DATE--------------------------------........................... <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------- -••---------------------------- DATE-----------------------------------. .................... <br /> Alterations and/or recommendations:--------------- •------------ - •------ --------------------•--._--.-..----------•---------------------------- <br /> --------------- !_�� <br /> ------------------------------------------------------------------------ -------- ---------------. <br /> _..-----•---------------------..-_..._..-------------------------- --- ------------...- --------------------------------..-------- -------------------------------------------._....•----------------------------------- <br /> ------------------------------------ -­..­------------------- <br /> ----------____________________________________________________________________ ........ _ __.._._._-_•-- --- __------------ .__________._..-_._....------------------------------------------------ _ - � <br /> FINAL INSPECTION BY: Date .� <br /> - ---- - ----- --------- ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9Th Str*41 <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5-59 8M a-61 ATLAS <br /> J <br />