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FOR OFFIC;E.USEL. <br /> ------------------------------------ ------- ----------- <br /> ----------- ------------------------------------------- <br /> ------..............._____.___.--..-___-..-_--__._________ APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> ------------------------ ------------------------------ (Complete in Duplicate) <br /> Date issued 111-1�_��S <br /> --------------------- ---------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora err to construct and install the work herein described.' <br /> This application is made in compliance with County Ordinance No. 549.x`" �(® _SCA Lo(,\! <br /> e <br /> JOB ADDRESS AND LOCATION._. ..YYu-.., � ..lt?a: <br /> s ,f'', s� <br /> . Owner's Name___.. '. ----------- Phone-`- -- ----------- <br /> C <br /> Address__----- _ A �/ . � ......1.,a......��. � -•-----•-•--•----•----------- <br /> Contractor's Name__J , }tts�, l �___ t Yt i _G= __L�ifi k._YA9 L'` AgafIt....... Phone.,EY!.7.-..174& <br /> Installation will serve: !Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other '"�►^� <br /> Number of living units: j-___ Number of bedrooms,.,--. Number of baths .)__-_ Lot size j oR ?A6------------­-­------------ <br /> Water Supply: Publiclsystem ❑ Community system ❑ Private M Depth To Water Table __&ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ©� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:- <br /> (No septic tank'ar cesspool permif"ted-if-public-sewer•-is available-within 200 feet.) �IvWj <br /> Septic Tank: Dis+ance from nearest well-_nIDF`�Distance from foundation.____In:.......M terial_.�:Ql _ _l..: ---__---. <br /> �No. of compartments___.__.A-------------Size----/ 'D f +:..:Liquid depth---&`--_-..-.------Capacity�SjgO.._..... <br /> F-- rt <br /> o t ff <br /> Disposal Field: ,-Di'stance from nearest.well-___&�°,�Distance from foundation-----f ___�.__.Distance to nearest lot line.__:. ?.........1�•'S'r <br /> /i ❑ .7u eberflitfines.__..-------------- ------Length of each bine_gP 4a 5.x_"�?..---..Width of trench.-c?_R�..................k- <br /> k yp er-material.....�.X�.t -Depth of filter material_i _• �------DTotal <br /> stancengohneaote._.: ___. <br /> Seepage Pit: Distance•to nearest well.--�cn.�t•-__Distance from foundation_..,.. . <br /> ' F Number of pits_------;2---------- <br /> Lining material__-- Size: Diameter- ---•--.Depth--,�c---------------v •. <br /> Cesspool: Distance from nearest well-----------------Distance fromrfoundation-_-._-----__-.__--.Lining material----.--_----__---------.-.-_--.._._._ <br /> J � <br /> '^ ❑ Siie: Diameter--------------------------------------Depth-------------�'-----------------------------------Liquid Capacity--------.-•--. -•--•-•-----gam <br /> `Privy: Dasiance fro m nearest well---.............Y_.__..----------------.'_'...Distance from nearest building______________.__--.._........_-_._____._. I <br /> ❑ nearest <br /> ` ' <br /> Distance to Wearest lot line ------'..__r____.___ -- ------ "�--.-_ <br /> -----.-�---.-/S-I--_•=- -------...----- ------------ <br /> ` <br /> Remodeiin9 and or rla arring'4(descri <br /> .4. --- ----- <br /> -------------------------------------------- <br /> -----------------------------------f4 •-•---- ••---- ........------------•---------------------..._ . ----------------------------------------------- <br /> hereby certify that Lhave prepared this application and that +he work will lie done in accordance with San Joaquin County <br /> ordinances, State laws, and'rules.and'regulations of +he San Joaquin Local Health District. <br /> (Signed)--- f t 1` d� i-P 1��` -------------------------------------(Owner and/or Contractor) <br /> ----- -- - <br /> (Plot plan, showing size of lot, locati - of system ir,;reEation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-___.-. --i- ._ _ r <br /> � �'-d-�- ------------------------ <br /> f .-- <br /> --------------------� --...-•----...._ - -•--�•----------------- DATE----*��""---��----�=--�--�--••------------------ <br /> REVIEWED BY----------------'------------ .... DATE-------------------- <br /> BUILDINGPERMIT ISSUED-------- '= - --------•.............I DAT E------------°------------------------------------------------ <br /> Alferations and/or recommen$a+ionsi----•-------------------- ------------------- ------------------ --....----....---•--------..-------------------------------------- <br /> -------------------•-------•-•--•------•-----------•------••--•----------- F--------------------------------...................•-----------------------------------------........................._......._...... ...... <br /> ---------------------------------------------------------------------- -- -----------"---- ---- ------ -----------------------------------------------._.._......-'--__•_------. ------.-----------_--------.------•------ <br /> ------------------------------------___ _..-_----------_.-----____..----------__-------------------------------------------------------.-------- <br /> ._. <br /> ~T70N <br /> FINAL INSPEC1 �j` lJ- ----- -- - Date------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT j <br /> 130 South American Street 300 Wort Oak Street,' ' y - 124 Sycamore Street 205 West 9th Street + <br /> Stockton,California lodir California y Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br /> i <br />