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........... <br /> - ------------- A <br /> This Date Issue <br /> ---- --- --- <br /> ------- ------ ----::2 A ICATION `FOR SANITATION PERMIT Permit No. <br /> ----------------------------- --------------------------- .............. <br /> --------­­------------- -------------------------- (Complete in Duplicate) <br /> This Permit Ex I Year From Date Issued d ......IZ,�.1 /k5 <br /> Application is hereby made to the San Joaquin Local Health District ...... <br /> This application is made - f for a permit to construct <br /> in compliance with County Ordinance No. 549. u�ctnd install the work herein described. <br /> JOB ADDRESS AND L N_ <br /> 40x� ... <br /> Owner's Name. <br /> ..................... <br /> ... .... .... <br /> .... ..... <br /> -------------------•---»------------- Phone.......... <br /> OF ------------ .......................... <br /> Address--------- - - - ----------- <br /> ......... <br /> =?. �p::1-4 --------------­--- ---------------------------------------I........ ................ <br /> Contractor's Name__ ....... <br /> ................................... Phon <br /> Installation will serve: Residence Apartment House E] Commercial Ef Trailer Court 0 Motel 0 Other ❑ <br /> f <br /> Number ❑of living units: ---/_ Number of bedrooms <br /> umber of baths Z_ Lot size <br /> a 'r <br /> .............. <br /> Water.Su pply: Public system P__�Community system 0 Private-E] Depth to Water Table 6.0 ft. )c- <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel Sandy Loam [] Clay Loam E] Clay E] Adobe Hardpan Previous Application Made: (If yes,date__ No [I New Construction: Yes El No 25--�HA./VA-. Yes <br /> Ty INSTALLATION AND SPECIFICATIONS- ❑ __1 No E] <br /> (No septic r cesspool Permitted if public sewer is available within 200.feet.) <br /> Sceptic Distance from nearest well------------------Distance from foundation <br /> No. of compartments <br /> Material <br /> -----------------------Liquid clepth--------------------------Capacity....................... <br /> �posal Fireld Distance from nearest well-t-AGXA-.--Di,_ta�n ce from founclatiogn----�(.O e <br /> Number of fines-' ---Length of each line___,.�,O -------_Disfance to nearest lot-line ......... <br /> Width of french C <br /> Type of filter mal <br /> I---Depth of filter material- 0 <br /> ___,,e_TotaI length...... <br /> Seepage Pit: Distance-to nearest well.AOL4 ------Distance,�m undafion <br /> Number of pits.-_ line._, <br /> fF to nearest lot <br /> -1--------------Lining material_.______ --- ---Size: h <br /> Cesspool: Distance from nearest well----------------Distance from foundation________________ ----Dept ......2.51�-------_---- <br /> 13 Size: Diameter--------------------------------------Depf h_........................... ---------Lining material------------------------------------- <br /> Privy: Distance from nearest well : <br /> -------------------Liquid Capacity----------------------------gals. <br /> 0, Distance to nearest lot line___.__---. "_•_---- Distance from nearest buildin --------- ---------- <br /> - ---------------------------------------------------------------------------------- ------------I <br /> 'ju"a'n - <br /> -------- -------- <br /> -------- --------- <br /> -------------- <br /> Remodeling and/or repairing (describe ------------ <br /> -- --------------------- -----------­---------- ------------­------­---- <br /> -- - ------- ....... <br /> --------­--------------I-----_--------_--------------------------- .. . . ...... ---­ -------------- ­_ W------------ 1------------------ <br /> 71 7----------*------*------------------------ -- ------­--- -------------------------- <br /> -------------------------------------- ---------------------I------- ..... ­ - ------ - -- ----- ----- - ------ -------- -----------------------------­ .............. <br /> ---------------------------------------------------------------- -------------- <br /> I hereby certify that I have prepared f --------------------------------------------------- <br /> Ices, S±AjQ ;;e�_ ��js application and that the work will 6 done in accordance with San Joaquin County <br /> ordinances, <br /> u <br /> ordinanc r,les and re5[uI4ions of the San Joaquin Local Health District. <br /> . <br /> (Signed)---. - -- --------- ------ <br /> ------------------------------- <br /> By:. -------------- Contractor) <br /> .................... .............. ------- <br /> -------------------- - 1 A itie)--------------------------------------------- ........ <br /> (Plot plan, showing size of lot, locafion"f system ' EF-11.j -------(71 <br /> 0 in relation so buildings can be placed on reverse side). -------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- -- <br /> WE Y -- -------- ---------- -- - --------------------------------- <br /> REVIEWED BY .......... DATE--- <br /> 3UIL - ------------------ ---- ------- ----- ----2—--------------- <br /> P ---------- --------- <br /> PERMIT ISSU D -------------------- <br /> E ---- DATE_.---- <br /> --------k----------------------=7!:� D�,TE <br /> Alterations and/6r recomm'eTt. t ----------------------- <br /> 9 Ponv ---r-------1. 4, , I I .............................. <br /> ----------------------------------- • <br /> :��--------6',�. ........12- --------- ---- <br /> -­-----­---------------­--- --- - ----- -- <br /> -----------­- ��_64 <br /> -------------------------------- <br /> -------------------------- -------------------------------------------- <br /> -- - -------------------------------- ------------------------------ <br /> ----------------- --------------------------- --------------- <br /> ------------------------f----------------------------------------------------_----------- <br /> Al <br /> ---------- -------------------- 1V;f <br /> - -------------- ------------------------ <br /> --­-------------------------- <br /> FINAL INSPECTION BY.:_-.. <br /> -- ----- Date_/_— <br /> ----------- <br /> ----------- <br /> 4A'q, �N4QAQyIN_'L0CA`I_ HEALTH DISTRICT <br /> S I <br /> 130 South American Street <br /> 00�wft�i'(Ocik' street <br /> A 124 Sycamore Street <br /> Stockton,California <br /> 300 <br /> Aodi,California:,-%V "- 205 West 91h Street <br /> I T _1 . M01119CO,California <br /> ES !W REVISED B-59 2M 5-61 ATLAS Tracy,California <br />