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1-UK Ut-HUL USE: <br /> ------------'SA- <br /> -------------------------- ------------- <br /> ---------- APPLICATION FOR SANITATION PERMIT Permit No. __,j`_......_... <br /> ...... <br /> --------------------------------------------------------- x P; <br /> (Complete in Duplicate) �3 <br /> ---------- Date Issued .-------- <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION...........4-16---/ F - . <br /> -- ------ ----------------------------------------------------------------------------------- <br /> Owner's Name__...-----;1V4Z_q1q4W <br /> Address .44----------V�----- <br /> ------------------------------------------*--------------------*----------------------------------------------- <br /> Contractor s <br /> 73—------------- _­•---- -----C---------------------------------------------------­------------- Phone................................... <br /> * <br /> e. I e k <br /> 1 ReIidence sApartment House [:] Commercial 0 Trailer Court ❑ Motel [I Other 0 <br /> Number of living' units: --j".=Nwinber of bedrooms .-N-3. Number of baths �s�ize <br /> ................ <br /> Water Supply: Public system 92( Community system F1 Private [I Depth to Water Table ........ ft. . bill- <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam 0 Clay Loam [j Clay E] Adobe[-] Hardpan 0 <br /> Previous Application Made: lif yes,de----_______________) No 0 New Construction: Yes Ej No C-] FHA/VA: Yes El NoO <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S ticDistance from nearest st wll--are e -----------f---Di0ance <br /> 'from foundation-------_-----------Material----- <br /> No. of compartmWs <br /> _, <br /> 4 --- ------------------!---Size -f�-- .............. ......---Liquid depth----------- I Capaci <br /> ---------------- <br /> D ispos Field ---- -- ty------------- <br /> D Distance from nea�rZ.`st well___.--------Distance from foundation_____`. Distance to nearest lot litre-----X..... <br /> qe70q umber of lines__ Length of!each line----------- ...... 'a. <br /> A-------Width of french-----7 <br /> -a <br /> Type of filter mafe Depth of filter material______ ____________Total length ------------------- <br /> See Pit 7­ <br /> Distance from foundation.....&:­'.jW 01sta.0 e to nearest lot)ine___. <br /> D ............. <br /> Vag , i Distance to nearest well. <br /> Number of pits__-_/-------___--Lining material--- ---_--Size: 1 <br /> 1 , - epf --------- <br /> Cesspool: Distance from nearest well_.____..__ Distance from founclaf Lininmaterial__.._-.________ <br /> ❑ Size. Diameter--- ------------------------------- Depth------------------------------ qm -------_------------- <br /> -----------Liquid Capacity------------_------ <br /> -------gals. <br /> Privy: Distance from nearest well <br /> --------- --- ---Distanc <br /> ._frm nearest builcling__------------------------------------ <br /> ❑ Distance to neaVst lot e <br /> ---------- --------------------------------------------------- <br /> Remodeling and/or repairing (describe) t.Z' eam <br /> ud- <br /> 0, <br /> -- ­ --------­------------ ----- --------------------------•---------------- <br /> ---------- ------ --------- -----------------------------------------------------------------------i--------------------------------------------------------------------------------- <br /> I I hereby certify that I have prepared this application and that the work Vill 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)-.1---/4--------- ------- ...... ------ - ----- --- _. F...... % <br /> -------------------------�' I. ---- --------------J-r-----------------(Owner and/or Contractor( <br /> BY:------------_---------------------------------------------------- ------------------t---!�--------------f---------- ­.Arltlo--------------------------------_­........... ............. <br /> (Piclocation'-.oflan, showing size of lot, location'-.of system in relifl;n.ttZ�elts, b <br /> o buildings,-efc., can 69 placed on reverse side). <br /> uildi <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- (�� <br /> DATE <br /> REVIEWEDBY--------------- --------------------------------------------------- ----------4;;----------------------—------------------ <br /> -----------------------------------------------------------------------------------------­­------- DATE <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------–-------------------------------------- DATE-------------- <br /> Alterations and/or recommend ations__________-- - <br /> ----- --------- <br /> ---------------_---------_- <br /> FJIO-----------_---------------------- <br /> ...............----------------------------------------------------------------- ------------------I--------------- ------------------------------------------------------------------ -------- -----­------------------ <br /> ------I——----------------I--------------- --------------­------------- --------------­ ­---------------I-----------------------_-----------------­­--------------------------------- ----------------------------- <br /> FINAL INSPECTION BY:..,A_0..---74/71r_u-----------•-------------------- Date--------- -- -------------------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Striet <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />