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FOR OFFICUSE:/ <br /> Permit No. <br /> APPLICATION FOR SANITATION PERMIT �.2 <br /> --------------------------------fl.:.%......P----------- 7 <br /> ... .......... ------------------------------------------ (Complete in Duplicate) Date Issued <br /> ------------------­­------------- -------------------- This Permit Expires I Year From Date Issued <br /> Application is,here6y made to the San Joaquin Local Health Dist 'ct for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance 549. <br /> JOB ADDRESS AND LOCATION... IT ------ ............... ....... ........ ................................................ <br /> 'Tn 'j"T <br /> .Health <br /> Owner's Name.....li2...../_7770�0" --------------- -------- ----- Phone................ ---------------- <br /> .. .... ..... --------------- ......... Phond;6.1V.... <br /> Contractor's Name n�-�, <br /> - ------------------------------------------------------- <br /> Address........................ e/1------- .....IQ. <br /> --------------------------------------------------------------------- -------- <br /> ......V—_57, —--------------------- <br /> Installation will serve: Residence E] Apartment House ❑ Commercial C] Trailer Co rt Motel E] Other <br /> Number of living units: =-. Number of bedrooms Number of baths size ___________________..--L Sa <br /> ----—-------------------- <br /> Water Supply: Public system Community system 0 Private [-] Depth To Water Table _4ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel F <br /> I Sandy Loam El Clay Loam E] ,Clay F Adobe 2-lHardpan 0 <br /> Previous Application Made: (if yes,date___.___..____.-___) No ❑ New Construction: Yes E3/lklo [] FHA/VA: Yes 0 No [I <br /> TYPE. OF INSTALLATION AND SPECIFICATIONS: <br /> Ir (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from fou?jt;on---/0........Material----- ---------Ley... ., <br /> Septic Tank: Distance from nearest well.-Wo, <br /> No. of compartments---._Z----------------Size. -------Liquid deptk_.5--Z?.... ........Capaci;,­.��--l­­.. <br /> V <br /> Dis I Field: Distance from nearest well.P07.L.e---1._Distance from foundation----40.........Distance to nearest lot line...... <br /> Number of lines.......I--------------------------Length of each line___-/V_49.-I-1--------- Width of trench. <br /> ------------ <br /> Type of filter material.�4,,J? _'-Depth of filter material_._,-_"--Tot;[ length-------------- g2-------------------- <br /> rest well-14.0-t%tt-------Distance from foundation--1_0---------Disiance to nearest lot line____._____ <br /> Seepage Pit: Distance to nea 11 <br /> Number of pits-_-_I._______.__._.__Lining mate -__.-_-Size: Diameter .... Depth <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------_Lining material.__.-_.____________..........._...... <br /> Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.______._______________________________ _______Distance from nearest building_______.____________.___._.__-__....__..., <br /> Distanceto nearest lot line_____________________________----------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)---------------------------------------------------------------------------................. ---------•----••----•--------------•------------- ' <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I' ----------------------------------------------------------------------------- <br /> --------_--_----------___---------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -----------------------------------------------------------------------------I------­--------------------- .............. .................................I---------------­-------------------------- ------------------ <br /> ----------------------------------------- -------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepar;d this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State s. d I d regulations of th San Joaquin Local Health isfrict. <br /> Vu es an <br /> (47 <br /> (Signed ----------t9iw�� Contractor) <br /> ___4--- -_ -_ -.4-Lq i <br /> By:................ --------------------•-•---------------------- --- ---------- - ------------------------(Title)----------------------- <br /> (Plot <br /> ------------------(Title)-----------------------(Plot plan, showing size of lot, location of syste in relation to wells, ui dings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- <br /> ..... ------------------------------- <br /> -- -------------------------------------------------- DATE- '-/- <br /> __7 <br /> REVIEWEDBY-------------------------------- ---------- ------------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED----_--_------------- ------------•---------------------•-------------- -------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommenctations:---- <br /> — - <br /> ------------------------ <br /> ------------ .......... ------------------- ------------- -----------------------------------------------------------------------I----------------------------------------------------------- <br /> ---------- --­------------------­_­------------------------------------------------------------------------------I...-------I------------------------------------------------------------------------------------------- <br /> ----------------------------------------- ----------------------------------- -----------­-------------------------------------------------------------------------------------------------------- -------------------------- <br /> ------------------------------------­...... _­------- -------------------I.................. ------------ --------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY-A./m..... - ------------ —-------------- Date------- .. <br /> . . ....---------------------------------------------------- <br /> tSN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak STreot 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 />