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FOR OFFICE USE: <br /> y <br /> -------------------- ------------- Permit Na. ..����.s <br /> APPLICATION FOR SANITATION PERMIT <br /> ,(Complete in Duplicate). Date Issued __--- •---.:� _ _ <br /> ----------•----- ------ <br /> This Permit Expires 1 Year From Date isue _ _ <br /> A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install tha r ghee d@scribed. <br /> PP �V <br /> This application is made in compliance with County Ordinance No. 549. S <br /> JOB ADDRESS AND LOCATION__: _. ta.----- p ®• '± �_ _ ''---'"_ - <br /> ,. <br /> ----------` _!Phone....-------------•-----•--•-----•--- <br /> Owner's Name-------- <br /> /� cDi-4 -��-•-- --- •-•--------------------t.-_-.. <br /> �F _ .... <br /> p..... <br /> Address.............. Q• ---- © DLpone�..... <br /> Contractor's Namem... -� 5 �1.--- - <br /> 0 <br /> Installation will serve: Residence Apartment House ❑ Commerci al�❑ Tra <br /> il r Court C] „„ - <br /> Motel E] Other ❑ <br /> Number of living.units: _.I�__". Number of bedrooms Y----- Number�of baths ._ .__. Lot size ..... - ff-a'�7='�--••---•-'-'-----"- <br /> Water Su i • Public system ❑��ommuriity.,�sysein�©,�Priva}e� Depth To Water Tab l'e 3 . ft• <br /> . P�'- Adobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ ❑ <br /> O R FHA/VA: Yes ❑ No � <br /> Previous Application Made: (If yes,date_________________--) No New Construction: Yes E] <br /> TYPE OF, INSTALLATION AND SPECIFICATIONS- <br /> TYPE cl �+� ;. <br /> (No septic tank or cesspool permitted if pubhc sewer,is available within 200 feeT) <br /> l # � t <br /> Septic nk: Distance from nearest well Dista afrom-fFT <br /> 0_=d_- tion___ - Ca aciQ <br /> No. of compartments------- Liquid deth-. ---- P tY <br /> f <br /> Dispos Field: Distance from nearest well-__ Q--.--Distance from foundation___..1Q_ ---•Distance to nearest lot I �-------•--••- C <br /> �'�^"~. _Num`b�r'of IiiYs”" "" � ",•�'-�_" """Ln�th 6f'eccli Fine-=-- -. --tr-- Width of trench---••- •---r--•- <br /> �] _Total len th `.t�C� <br /> Type of fitter material._ ----Depth of filter materia <br /> est <br /> 9 r. <br /> //.,.,, -Q_..._...Distance to nearest lot ling.___- ---- <br /> Seeps Pit: Distance to nearest weIL�CP .:______Distance from foundation___. l� De th_____ _ - <br /> Number of pits---... ----•-----Lining material-- C.JA Size: Diameter- ___ .. __ p �� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation____________________Lining material---------------------­------------- <br /> f_1Size: Diameter <br /> --------------------------------------Depth-----:------------7 ----- Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------- - - <br /> ____Distance from nearest building----------------------------------------- y_ <br /> ❑ -------- --------•--- ------•------ <br /> ------------------ <br /> Distance to nearest lot line-------------------------------------------------------------- <br /> -------------------- ------- -------- ---------------•---• . <br /> R* <br /> Remodeling and%or ire ,airing (describe):----------:----•---------- - = :_.... <br /> • �".r ----------------------•----•----------------•-------------------------- ---•---•------------- <br /> - <br /> --- ---•---•--------------------•-------•---------------------------------------------- <br /> I hereby certify that'I have prepared this application an that the work will be done in accordance with San Joaquin County <br /> 41 ordinances.4tate 1awsh',acid rulesrand*regul 'ons*�o ,tlh, Sa ,Joaquin Local Health Dist#riot. 1# <br /> - Y --ti'.r4 " (Own r and/or Contractor) - <br /> i� t Signed)_ f� -; - - _ ------------------- � � -- _• - � - <br /> _. --- , <br /> % <br /> 1 <br /> By*--------------------------------------------------.--------------------------- ------------------------------------------------ <br /> (Plot plan, showing size of lot, location of system in rely ion to,wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> — <br /> APPLICATION ACCEPTED BY-------------I--- p ---------------------------------------------------- DATE--=- -_! �` ^ 6-��----'---------------- <br /> �---+ = <br /> ------------ DATE----------------------------------------------------------- <br /> REVIEWED <br /> ------------- ---------------------------------- <br /> REVIEWEDBY---------------------------------------------------------------------------------------------- ---- DAV ------------------------------ ---------•-------------------- <br /> ` BUILDING PERMIT ISSUED--------------------------------•- ----------------- <br /> -------------------- <br /> Alterations and/or recommeneations:_.-------- ------------------------------------ -------------------------•-----•---------•---•-----•---------•------• , <br /> { ..--------•--- <br /> ---- ----•----- <br /> ----------•----... <br /> - <br /> -------------------------" <br /> --•-------------- <br /> ` <br /> _______ __-_______: <br /> FINAL INSPECTI ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 130 South American Strut TracCalifornia <br /> Stockton,California Lodi,California Manteca,California y, <br /> E5 9 REVISED B-59 2M 5-62 ATLAS <br />