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OFFIC SE3--L10 <br /> ----- - -------- �f3 - .?_ APPLICATION FOR SANITATION PERMIT Permit No. C _.. �_3---- <br /> 9--J (Complete,in-Duplicate) v <br /> ,.._,_ Date Issued .___ _� - <br /> - ------ ------ ----- ----------------- ------ ---_: This Permt'EzpZre�'1'Year From Date Issued <br /> Application is hereby made to fhe San Joaquin'Local Health District for a permit to construct and install the work herein described. <br /> This application"is-made in compliant w"th;-,Counfy Ordinance No. 549. <br /> JOB ADDRESS AND,LOCATION-- f` _ :`----�.- --�d-?5---__ �_:-------:----__`_- L <br /> N-P�-N <br /> Owners ----------------------------------------------------- Phone "`- <br /> Address---------------- a �� ,------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- <br /> Contractor's <br /> ---- ----•----------------Contractor's Name-----�._ __ �:--:. .;!'�. :' ,_1St `*-----a-0-ri--------------------------------- ---------------- <br /> Installation <br /> -•- -- <br /> Installation will serve: Residence /'--n'�Apartmentr-House ❑ Commercial ❑ ,Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -:-I __ Number of bedrooms :-:`N,umber of baths -rte_: Lot size:------�a------ - -=------------------------------- <br /> Water Supply .Public syster ❑ Com unity system E] -.Private VDepth to Water Ta0e _:49 ft. + *` <br /> Character off soil,to a depth of 3 feet: --Sand E] Gravel E] Sandy Loam E] Clay Loam E Clay E] Adobe E] Hardpan ❑ <br /> Previous Application Made. (If yes,date-`"r-~-;---------�: No New Construction. Yes ❑ No []" FHA%VA:rYes ❑ No [� <br /> N. f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic 'tank or cesspool permitted.if public sewer is available within 200 feet.) Y _ . <br /> Sepfic Tank: Distance from nearest well:__ '._-__...._ Distance from foundation____________________Matenai-----.-.---------_..----_---___-----__----------. <br /> _ F - a4. No. of tomartments_______ _ _ ____ Size________._ _ _____-._- .-__Liquid de th ------------ -----Capacity----------------------- <br /> III <br /> Disposal Field: Distance from nearest well­_.6.U'-__Distance, rom foundation­­:/(9--`­:Distance to nearest lot line------ _-.--.--. (� <br /> Number of lines_____________f ____.._-- Length of eachline__..-.. _fC1Q..........Width of trench._-__ .�L_` .-'---------- <br /> pLJ-4..�,.�.,,..Typ�e;of,filter material--: r?. � _.,Depth of filter material-_--__-/10 _._Total- length------------ ___-----/A9.-._..---- 1 <br /> -Seepage-,pi 'Distance to nearesttwel4Distance from foundation.___1 ..___.Distance to nearest lot line......5.......... <br /> , . Size:'. . Depth—rnber of Lining material -- . DiameteFJ--V---$�---NuE <br /> Cesspool: Di tanceflommnearest <br /> weJ1- __ .-_--!Distance fr"om`foundation-------------------Lininmaterial­--------------------------------- <br /> Size: Diameter----------------- ---;De th_-- <br /> ' ` ...__..Liquid Capacity gals. <br /> Privy: Distance.-.from_nearest,well-.___:___-_(----------- - ---------------Distance from nearest building_--------------------------------------- <br /> ❑ - ----•--------- --•---------•---------•........ <br /> Distance;to nearest lot line------------------ -- ---------- ---- - - --- -----------=---------- ----------------------- <br /> I Remodeling and/or repairing (describe):-----AAA--------4Q.----- --------- '---------------------------- <br /> _-_ --------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- <br /> r <br /> I dMiq"`, c r i <br /> n� <br /> N <br /> _ _ _ ________<_ _ _____ _____________ __ ______-_.- <br /> ordinlances 65tatet lawsh andh utas and are dulat ons of the:San J� r l y <br /> ' y y p p pp at the work"will`be"�d`one-in accordance with San Joaquin County <br /> g aquin Local Health District. <br /> (Signed]- - .•_ -rt:_.. ---------- `✓ - -- '- .ct ---------------------(Owner and/or Contractor) <br /> Ian .� <br /> -------------------------------------------------- i - <br /> (Plot plan, showing.size.cf lot, location o-;system in relation to wells, buildings, etc., can l7e placedon reverse side). <br /> FOR DEPARTMENT USE ONLY, s` <br />' APPLICATION ACCEPTED BY_ -1/C�: �! -------------------------------- * <br /> REVIEWED-,.BY- - - ----- --------------- ------------- ----- ------ ------- ------ ----- ---•---------------R' IATE --- ----- <br /> i BUILDING PERMIT ISSUED } = DATE ------------------ --- -------- --------' <br /> Alterations and/orrecom :'rl <br /> mendations:__- ..__nr.- _,_.._-{.�., ..__ _. ---------------------------- - -- <br /> i �r`�a"Ft✓ Bim- ---- c,—a t.�,. f.,��r-�_ � � �-��� <br /> re 'macet �<- i -- ' 1:---- / -.____ --- ? - <br /> - .......... <br /> (y 5+ <br /> -------- I--------------------t-- -------------------------------------------------------------------------------------------------------------- ------------ -------------------------------------------------- <br /> FINAL INSPECTION BY: � -------------- <br /> ---------------- Date .' --- `----------------- --- -------------------- <br /> r300 <br /> fs ---a; <br /> ' N-JOAQUIN LOCAL HEALTH DISTRICT <br /> } 1601 E.Ha:eifon Ave. est Oak'5lreet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California ..� ,California Manteca,California Tracy,California <br /> Ili} E5 9 REVIEEo 91 3M 3-'63 F.P.CO. 1 r <br />