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----- --------FOR OFFICE USE: j �,' ...----�.�.-----•-- . <br /> ----------- Permit No. <br /> APPLICATION FOR SANITATION 'PERM � <br /> _.--------- ----- (Complete in Duplicate} — Date Issued ��, �D S <br /> - This permit Expires 1 Year From Date Issued <br /> Application is herebymade to the San`Joaquin Local Health District for A'permit to construct and install the work he ein described. <br /> Thisapplicationis mde in compliance with County Ordinance-No. 549?�b..i "e _ AI <br /> ell <br /> JOS ADDRESS AND LI iCA ION I4 1�} --- -- . - --- -------r/�}C <br /> O <br /> i <br /> Owner's Name---- ----- ��� Y�...- - 1 fQ} Ph <br /> -------­----------------- <br /> Address <br /> �e <br /> Address--------------- <br /> -----•----- --------------------One <br /> Phone--------- <br /> Contractor's Name . %-=_ ----- ------- ---- <br /> ,.-- --- --` <br /> Installation will serve: Residence artment House ElCommercial ❑ Trailer Court [I Motel ❑ Other [] <br /> Number, of living unit��; '+ y F �1 §'. <br /> *k-- Number of bedrooms _ -_,Number of biaths�.._3ot size ---- ------ <br /> b 1 ryl/' * --r <br /> Water Supply: Public�epth <br /> system ❑ Community sy-stem ❑ Private l9 Depth to Water Table _'?ft. <br /> sW- ' s 1 � <br /> 1 Character of soil to a lof. feet: Sand 0 Gravel ❑ Sandy Loam I F CI Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> i _ _ Y ,. _L -.,_-,te r--r ,�N -Yes 1\10.❑ f_HA <br /> Previous Application Made•�(If yes,date-.- �-_ No ew Construction:_ <br /> ~ TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if-public sewer is available within,200 feet.) t. <br /> Septic nk: Distance from nearest well--5- -;Distance from foundation--I -------------MateraL-_-.- <br /> (- Size-! <br /> Capacity--- <br /> No. G <br /> of compartments----- X� --x--{� Liquid depth---- - ---_may-f--- <br /> Disposal Field: Distance I i � �� F ��-------Distance to nearest lot line---�---_---- <br /> l from nearest well.._ :,Dista cj fro f undation..-- - L <br /> I Number'* -. Lenotea�h`lin W - / r V , <br /> of lines h of trench------------ ----- <br /> i <br /> Type of filter material_ 0.R _ Qepth�of filter.matenal _.__ ------Total length_______________________ _ _ <br /> Seepage Pit: Distance to nearest well--:"" --------------D'istanae-from foundation--------------------Distance to nearest lot fine------ .-____---_ <br /> ❑ Number of pits.---------- ;--- Lining material)-o-11- ..Size: Diameter-------- -------------Depth___- -_-.- --------------------- <br /> Number <br /> - ---- <br /> II 11- <br /> e from nearest well',--__-:___ DisfanZe from foundation--------------------Lining material------------------------------------- <br /> Cesspool: <br /> ---...---.---_------_---._--..-. <br /> Cess ool: Distant _ -- �De th = ---------------------Liquid Capacity----------------------------gals. <br /> p <br /> ❑ <br /> Size: Dia�eter---------------------------. ----- P <br /> f _ --------,-'{---Distance from nearest building------------------------------------------ <br /> Privy: Distance from nearest well_----- -____------- <br /> ❑ Distance to nearest�•lotline-�.r--— _ -- - -- <br /> s-- - - - -- -- <br /> Remodeling and/or repair'ng�(describe�=-------- ----------------- -- =_- - .. <br /> i <br /> �1 yr r ��i t.n T ---- <br /> -----0---------- --- -- ------------------•------------- --- <br /> I I f,r,. rt a6kArf <br /> -------------------- <br /> -----------------=--------------------------------------------- ------------------------------------------------- <br /> i hereby certify that I-h'a a Ire tired this application andiE+hat the work will be done in accordance with San Joaquin County <br /> i ordinances, State laws, and rules d regulations of the San oaquin_Local Health District. <br /> -. _-- ,.---z.n_._-..------------- ----=(Ow er.and/or Contractor-� <br /> F _ _ -- ------- <br /> t • ------------------------ = ------- ------------------ (Title) <br /> -` :.---- ••-:------.•---•----'----------•-------..-'-- y `-; - g P verse side}. _ <br /> (Plot plan, sh wing.size of lot, location of system in relation to wells, buildings, etc., can be laced:on re <br /> FOR DEPARTMENT USE ONLY x <br /> APPLICATION ACCEPTED BY--- T� `�" -• -- - ------------------------------------------- DATE ----:�''--- `-�." FSC = <br /> ! - DATE-----------------------•---------------------------------- <br /> I REVIEWED BY--- - --- -----: -------------- = - -- ----- -- :- ----r <br /> BUILDING PERMIT ISSUED--------------------•------- ------ <br /> . <br /> Aktera+ions and/or. recommendations: - -•---- - ----------�=- '- ; <br /> nAq. tA7- ----------------------------•------------- <br /> " ---_-----------------------moi�.y_�'.• y ,...... �,; <br /> I ------------------------------------------- <br /> -------------- <br /> ---- <br /> II <br /> ----------- <br /> -- ---- ----- ---- - <br /> FINAL INSPEC 1------------- -- Date--- ------ - <br /> . , <br /> ! SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hczolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 3M 3-'63 F-F-CO. <br /> r <br />