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SE:-- FOR OFFIC USE.- <br /> --- <br /> - ---- -- <br /> Ile <br /> ._.._-- -___ -.- .� -_ ------ APPLICATION FOR SANITATION PERMIT Permit No. -_4 ` <br /> ---------- - --------- -------------------------- (Complete in Duplicate) ) / <br /> ------------ This Permit Expires 1 Year From Date Issued Date Issued <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 inanc o. 549. <br /> JOB ADDRESS AND LOCATION--------- .1 O +- A ' <br /> - .. +> .�----- -r--- ., ------~---'------- <br /> , .n n j <br /> Owner's Name--- - 'UTA�..Lt�.(l -C �i.� --- ---------------------- Phone.#-v ----•-.. <br /> Address----------- <br /> Contractor's NameSZ;;Z .._ ......... Phone....... <br /> � <br /> Installation will serve: Residence ❑ A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ,-_, <br /> Number of living units: ___.--.- mber of bedrooms ._-0. Number of baths _ ___ Lot size .... -��...___x-�(.{�`��.... ............ <br /> Water Supply: Public system Community system [IPrivate E] Depth To Water Table : ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe Hardpan El <br /> Previous Application Made: Of yes date____________________) No E] New Construction: Yes E] No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> n <br /> Septic Tank: Distance from nearest II_�.Distance from foundation__�_l0_/.__.....Material------ �L.. -tom__•. �.�„` <br /> No. of compartments_________ _________Size _�,t%�P_.___Liquid depth___17_7._.,----------Capacity__.40_0--a , <br /> of <br /> Disposal Field: Distance from nearest wellA,lYtJ--J__Distance rom foundation._4—r.j0_0_.__Dlstance to nearest lot line_ '�.__!�... <br /> Number of lines__________ --------------- <br /> _____________ Length of each line-44—XV -__..........Width of trench..c17_,rZ!!___.._____ <br /> Type of filter material. Depth of filter material---/ e�`'`C_.•._.Total length---------------_----_____�__`_-._ r <br /> Seepage Pit: Distance to nearest __Distance ro __. <br /> m foundation_---- _ Distance to nearest lot line________ <br /> _ <br /> Number of pits------_l_lwell_____________Lining material. __ Size: Diameter-.-.-s5��____.Depth_____-ZX-f__..___________ <br /> Cesspool: Distance from nearest well-----------------Distance from oundation-----.--------------Lining material-------------------------- <br /> ...._._.... <br /> El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gats. �. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-_____-..--_.____._----............. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------- ---------------------- <br /> Remodeling and/or repairing (describe)------------- ------------ ------- ---------------- --------._.. -----•-----•-------•---- ----------------------• -•- <br /> -----•• ----------------------------------------------------- -•-----• ------------------------------------------- <br /> -------- <br /> ••-----------------•-----.-_ ---•-------- <br /> -.---- <br /> r - ---­-------­ ------•-----�= --- - -- ------------------•--------------• -------•------------•-------.-----------•-----••---.-A--------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances t e laws and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----- -- - - -----•-------•--- ---- til-T,, 4 -ztn----- r------------------------------------------------- ontractor <br /> 9 <br /> By: (Ti+le) ----------------------------------------------------- - <br /> (Plot plan, showing size of lot, location of system in relati we s, 6uildi s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----~ -- --- - - - -------------•---------••-----•------- DATE----- t* ------ �------ <br /> REVIEWEDBY---------------------------------------------- - ---------------------------------------------------------------•-------..... DATE--------------------------••------,------------------------ <br /> BUILDING PERMIT ISSUED--=------ ---- ---•-•----------------------........................ ---------- DATE------------------------------------------------------------- <br /> Afterations and/or recom enctalions--------------- ------ •------- ----- - - -••--- ----- - <br /> ---------------------------------------------------------:---------- ------------------------------------------------------------------------+--,--T—-------------------I------------I <br /> •-••------------------ --------------------...__--_-__...._-.------------------------------------------------------------------------------------- -------------------------------------------------- <br /> FINAL INSPECTION BY:.---t _-:---- --• CL-------- Date---.---3-----_— <br /> r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California toell,California Manteca,California Tracy,California <br /> E5 9 REVISED 8-59 2M 5-62 ATLAS <br />