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ry vrrl t u t: <br />- -------- ------r-------""" - __ APPLICATION FC)R SANITATION PERMIT Permit No. __.Z�d� <br />- �. 1 3 <br /> .................. <br /> -- ------- -------•-�----- r----- .______.__ (Complete in Duplicate) �/ <br /> ------ This Permit Expires 1 Year From Date Issued Date Issued .___.l_ __6.-`Z_ ` <br /> Application is hereby made to the San Joaquin-Local.Health.District for a permit to constfuct and install the work herein described. <br /> This application is made in compliance with County Ordinance,No. 549. <br /> i $ <br /> JOB ADDRESS AND LOCATION.............. ��`t}---- ----- asp ._.------•- <br /> ----------------------------•---• <br /> Owner's Name------------- Phona.x 3.!7.S_. <br /> �r <br /> Address.......................... 3 .+t�fS 42[, - j f4 <br /> --------------------­---- <br /> 4 �... <br /> r -------------• ••---.......----•---•-----•--.._...-----••---- <br /> Contractor's Name ---------------------------------------- -------------- _ ---•-- Phone................................... 1 <br /> Installation will serve: Residence IX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___I____ Number of bedrooms __ __ Number of bafhOy4_ Lot size ____: _ - ..... .__. _ ...................... {'" <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water-Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan <br /> P ❑ ❑ Y ❑ Y ❑ Y ❑ ❑ ❑. . I <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes p No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: .1 ' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.): <br /> Septic Tank: Distance from nearest well <br /> ---_.rDistance orn undation..__/D........ <br /> No. of compartments----------- <br /> ----Size......q__K.q..X_,5 Liquid depth_____-____-y-�-._.___.Capacity_-..�.-Q.. <br /> f ♦ f <br /> Disposal Field: Distance from nearest well----467C3-_,-Distance from foundation-----?!�Q-...'.._.Distance to nearest lot line______........ <br /> Number of lines----------------�_- __-_-------Length of each line--------410-`---=- ----Width of trench_______..��._......----------- 1 <br /> ? Type of filter material• eaZDepth of filter mate rial-.'__f4 -------Total length------------.7,4^Q.'!_-------------- <br /> 'Seepage Pit: Distance to nearest well----------------------Distance from foundation---...__-__________.Distance to nearest lot line_.....__.______': <br /> ❑ Number of pits----------------------Lining material---------------------- -Size: Diameter--------- --------------Depth............----------------- <br /> Cesspool: Distance from nearest well_-------------_Distance from foundation--------------.:___.Lining material------------------------------ -_ <br /> ❑ Size: Diameter--------------------- --•-------------Depth-----------------'--------------------- ,------Liquid Capacity------------ gals. <br /> Privy: Distance from nearest well-------------------------------------------------Dista ce from nearest building-------------..-•------------------------. <br /> ❑ Distance to nearest lot line--------------------- - ` <br /> Remodeling and/or repairing (describe)-------------------------------------------------•_......_- _i'---=r t <br /> •----------------------------••-----•------------ -------•----------------... ----------------------•-- ---- <br /> -----------•--•--------------------- <br /> - -----------------------------------•----------------------------------------------------------------------------------------------- <br /> i <br /> hereby certify that I have prepared is application and that the work will,be'done in accordance with San Joaquin County ` <br /> ordinances, State I , an ru s and re i tions of the San Joaquin Local-Health District: <br /> (Signed)_-.X ------------- ---------------------------------------••--•---- __....(Owner and/or Contractor] <br /> By:----------------••----------•------------ --- • ­------------------------------------------------------------------------------(Title)------------------------------------------------------------ <br /> (Plot plan, showing size of lot, IOCON n of system in relation to wells, buildings, etc., can be"placed on reverse side). <br /> OR DEPARTMENT USE ONLY <br /> FF 9 <br /> ----------------------------------------------- <br /> APPLICATION ACCEPTED BY DATE...... <br /> �f 6 �Dj ► <br /> REVIEWED BY---------------- <br /> 'j -- ------------------- -----------------="-------------•--•------_-------------. DATE--------------------------------- <br /> ---•--------------------- <br /> BUILDING PERMIT ISSUED--•- -------------------------• --------- -------- .......----------------------------------------- DATE------------------- ------------- -------------------------- <br /> Alterations and/or recommendations:"+"-__ _-« ��`� 4 -f� zi Z <br /> .fin —fes _-� Q -`' lC ._`. `� — -_... <br /> --- --• -- ----------- -3.. ------------------------------------------------------ <br /> ------------------•--- <br /> ----- <br /> ------------- ------ <br /> -•-------------------------------------------------------------------------------• ----------------------------------------•---------------------------------------------------------------------------------------- <br /> i <br /> r <br /> FINAL INSPECTION BY: 9K -- ------ ----- '" `"---:--- -n Date. :. - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srreet 'r;� 124 Sycamore Street 205 West 9th Streit <br /> Stockton,California Lodi,California Manteca,California Tracy,Californias <br /> E9 9 REVISED 6.59 8M 5-61 ATLAS <br />