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FOR OFFICE USE: <br /> ----------------------------------------------------- /S 2 �{ �l <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___......•--•--------•-- <br /> -------------------------- - ------------ -------------- (Complete in Duplicate) <br /> ........... . .... Date Issued <br /> ------------------ _ ----- -- -.. This Permit Expires 1 Year From Date Issued <br /> - ZZq— lGo�S <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 Count Ordinance No. S49. C�� <br /> � 1�4�7y� <br /> JOB ADDRESS ND LOCATION.-Sf j� - �.�n(_�r ,-,t �- -- ----j l 1fZl-----E -.__J'1►W- ........ a...... <br /> Owner's Name <--- Q1}iLjtq A. 1 F�------L1�J l�}L,��-'.,-- -- - Phone- ------- <br /> Address <br /> ------ <br /> F/ C }� <br /> Address - ----.2 __. r--1_� .... --------­--------------------­..­........I <br /> Contractor's - -------------------•------------------------------------------ Phone................................ <br /> Installation will serve: Residence erApalfment House ❑ Commercial ❑k Trdailer Court C] Motel El Other ❑ <br /> Number of living units: -1------ Number of bedrooms _5 Number of baths l_ .,Lot size .__ ��A.l _____________________ <br /> -j _ <br /> Water Supply: Public system Community system [IPrivate Depth To Water Table35. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam' [ lay ❑ Adobe❑ Hardpan <br /> Previous Application Made: {If yes,date--------------------) Nom New Construction: Yes"jj_j%-No ❑ FHA/VA: Yes ❑ Nov, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <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---!Q-__--__Ma�erial_e01 _ --�_____. N <br /> No. of compartments...��__-_____________Size. dA7.-X5-`Liquid depth___ _._____Capacity_/� <br /> _ <br /> Disposal field: Distance from nearest well-_..��.._Distance from foundation___. _/�_._.._....Distance to nearest lot line•___-5. <br /> + Number of lines........ _ Length of each line...... __ ----------Width of trench.....!..3,16.tC / <br /> Type of filter material..�OC'.�.__-Depth of filter'�aterial___._r0-1_`____.__Total length------------ ___._-__So. <br /> Seepage Pit: Distance to nearest Well____�__,___Distance from foundation_............Distance to nearest lot Ijne__'_,�^ <br /> Number of pits_._ __-______ g' <br /> ' �x�� -------Depth'-fQ-lt.'---_._..._ <br /> �� Ln materia{.__ �GK___.5ize: Diameter_ ___ _______ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_ 4_.__..._..._._.... <br /> ❑ Size: Diameter---------------------- - -------------Depth------------------ ---4----(".'"I------------Liquid Capacity..... `--.....__..gals. <br /> Privy: Distance from nearest well-________________________.______-______ __. _--Distance from nearest building---------------------._.....____.___..._. <br /> ❑ Distance to nearest Igt jin9.,...... — ' ------------------------•-------- <br /> � r <br /> Remodeling and/or repairing (describe):------------------ ' . 'Y -----------;_--------------_----•------"- i.'..�~.---r _-�-•--•- .. <br /> ..................•-•-•-------••-----------•--•---.....� r -Z/- ----•------•------------------------- <br /> ---------------------------------------------------------------•------------------• Z----------------------------------------------------------- <br /> I hereby certif th?77r7 <br /> hared this application and that the work will be done in' cordance with San Joaquin County <br /> ordinances, State s, regale ' s.,of,the,San.,.Joaquin,Local Health District. <br /> l� <br /> (Signed).---- --/---- - ---------------------------------------- ----=------- (Owner and/or Contractor)By-•----------- ------ --------- -------------------------------------------------------------- '(rtle) - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,:can'be placed on reverse side). <br /> 1 + , _ <br /> FOR DEPARTMENT USE ONLY, <br /> `. <br /> APPLICATION ACCEPTED BY----------t---2- -- -A- ---------------------------t-----.,�--#"s-"`_"' - --------- <br /> REVIEWEDBY--------------------------------------------------------------------------------------------------------------2-------------- DATE-•-•------------------------------•--.. ----------------- <br /> BUILDING <br /> -------•------- <br /> BUILDING PERMIT ISSUED................... --------------- ---------- DATE:r:-`= ------------:----=----------------•------------ <br /> Alterations and/or recomrnend'ationS_:' -------------------------------------- - ----- ----------------•----------------------------••----•------------- <br /> F i�� . � { '� ,s <br /> ------------= -------- ---------------------------------------•-----••---------•------•----------.-_-..-------------------.- -------------- <br /> a------------�- -..--.iA K 11 _ x-t�. A----------- a-K-------...PCTs-------oJ4--------- �- -©` .... <br /> -- ---- ------------- ..................... - -- - <br /> ---------- --- ----- ----------------- <br /> r; ------- <br /> FINAL INSP +� Date------/77 7 ------------•---- ---- -•------- <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Serset 124 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r <br /> ES 9 REVESEo 8-59 2M 9-62 ATLAS <br /> 1 <br />