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rQKUr!­[C,t U,)t: <br /> ------------------------------------------------- <br /> -- ---------- ------------------------ -------------- APPLICATION FOR SANITATION PERMIT <br /> Permit No. ... .. ... <br /> ----------------------- ------------------------ <br /> � t ­ ­ 1.1 -.6- ...- _, -(Complete in Duplicate) <br />--------- - <br /> -------------- ----- -------------------------- r -This Permit Expires I Year From Da"t-o'lls Date Issued -.1/27 �.2,- <br /> --�j <br /> evas <br /> - <br /> -A plication is hereby made to.the San Joaquin .Local Health District for a permit"to construct and install the work herein described. <br /> This <br /> application is made in c-ompl.ia.nce with County Ordinance No.-549. 4. f <br /> 0 <br /> ATION <br /> ,+j�.X- ? <br /> ., -; , / -­-------- io .................. <br /> JOB ADDRESS AND LOC 7e, ") <br /> . 7� ;- ----------------- <br /> Owner's Name... <br /> ------------- <br /> .. ...... ... .. . ....C- <br /> ---------------------------- ------------------------------------------- <br /> .......Phone................... <br /> ................ <br /> r 3 <br /> W� ra <br /> Address..--...............3VC-1 <br /> Z 4 <br /> ---------------------- <br /> Contractor's Name------ <br /> Phone-,.................................. <br /> ---------------------- ---- ----- -­I I t, t-, <br /> ­ 7- . ----------------------------------- <br /> Installation will serve- Residen8le 0 Apartment House ❑ Commercial- f- Trailer... Court, .1 -4 -[3 r-- <br /> Motel [] Other ❑ <br /> Number of living units: --- Number of bedrooms N'umb7er of baths J---- Lot size --------- <br /> ----------------- <br /> Water Supply: Public system Community -s,ystern 0 Pr Depth to Water-Table......­­ ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam 0 Clay 0 Adobe 0 Hardpan <br /> Previous Application Made: (If,'yes,date--------------------) No ❑ New.Construction: Yes.'El. 'No FHA/VA: Yes L] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available'within.200 feet.) <br /> ------------ .................................. <br /> Septic Tank: Distance from nearest well------------------Distance from foundat'ion----------------- M <br /> 7----------------- --------Capacity-- <br /> i <br /> ---------------------- <br /> 0 No. of compartments-, Size-------•-------- ------- -------Liquid depth----------- <br /> Field: Distance fr <br /> om nearest well----- foundation_____ .0.. _'___.Distance to nearest lbt line...` <br /> `---------- I... ­ .............. <br /> Pr Number of lines----------I - ------Length of each line':............ ---------------Width of trench . 2� , r, <br /> : . ..­- -------------------------- <br /> Type of filter mate ------! Total <br /> material_____ ___- ,,:Depth of filter material..!�J-j! -_=_._Total !Y-A.°:.._-___-........_.____. <br /> Seepa/ePit: Distance to nearest Distance from foundation-_--l 6 to nearest lot lin el__._ <br /> ....__t.' <br /> Number of pits____..__l______-.___Lining maferial-­Ae.(tA.-.--Size: Diameter____ -.3-3__3.-_.`..__Depth__' - <br /> --------- <br /> ------ <br /> Cesspool: Distance from nearest well-----------­----Distance from, foundation------------ ........Lining material------------------------------------- <br /> ❑ Size: Diameter-------------- --------------------Depth------- ------ <br /> ------------------------Liquid. Capacity------------------------------gals. <br /> Privy: Distance from nearest well_.__________________________'_________._-- Distance from nearest builcling'­,-------------------------------- <br /> - <br /> ----- <br /> Distance to nearest lot line <br /> Remodeling and/or repairing {describe): p <br /> -------------- -- ---------------• ­------------------------------------........................... <br /> ...................--------------------------------------------- ---------- 4 � , f�- ". I " . ---••--•----• - - - <br /> -------- ----- ------------------ --------------------------------------------4--------------------------......................-------------- <br /> -------------------------------I------------------------------­----------------------------------------------------------------------------------------------- ...........I--------------------------------........... <br /> - <br /> ------------------------------------------------- -------------------------------- .................. <br /> -­­---------------------------------------------------I——--------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the' *11 be done in accordance with Sa—ri­J6aquin County!s, Sta ""hi <br /> ordinance laws, and rules Aanregulaif;tons of the an Joaqui. Local n Local laith Disflicf., <br /> (Signed)...... <br /> -­------------- ------------ ----------------------------------------------(Owner and/or Contractor) <br /> ---.,;,By----------------............. --------------- <br /> ------------------ .................... =(T ---- ----------------------- ..................... <br /> (Plot plan, showing size of lot, location.of system in relation to Wells, buildings, etc., jcan'be.placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -------------------------- <br /> APPLICATION ACCEPTED BY-- <br /> ----I------------------------ DATE-- <br /> _. <br /> 1,11_ <br /> REVIEWEDBY---=--------• -------------I------­-------- ------------------------------------------------------------------------------ DATE........................ <br /> BUILDING PERMIT ISSUED-------'..__"­ ------------------------------ -------------------------- DATE----­----------------- <br /> -- ------------------------------- <br /> ------ ----------­­­------------- <br /> -- -. ---.Aherations and/or recommendations:_-__ --- ........ <br /> ------------------------------------------------- ;------------------------------------------------------------------------------ --------- ------------------------ -------•--=-------•------------ <br /> u <br /> ------------------------------- <br /> I------------------------------------------- -------------------------------------------------------------------------------- <br /> ------•--•------------------•--- <br /> k ------I-------- <br /> ...................----------------------------------------------------- -- ------------------------------­­­--------------------- <br /> ----- ------- -------------- ------------ .............................;----------- <br /> ------------------- ........................ <br /> ------------------------ --------------------------------------------------------------------------- ---------------------------------­------- --------------------- <br /> FINAL INSPECTION BY, -- <br /> Date__. _. <br /> ------- -------------------------- <br /> -- ------------------------------------- --- <br /> SAN jOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak S?re*t 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad],California Manteca,California Tracy,California <br /> ES 9 REVISED 5-59 2M 5-61 ATLAS FF <br />