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FOR OFFICE USE: r <br /> Permit No. ._. ... S <br /> -' APPLICATION FOR SANITATION PERMIT /... . <br /> (Complete in Duplicate) Date Issued ,s <br />-------------___.___._----------.----------------------- This Permit Expires 1 Year From Date Issued <br /> .....�.:�__.� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinan o. 549. 1/i]/ /Y -Z,'9. Z �=2 <br /> 4,1 �T P/ <br /> 7�Yy--------------- ------------------- ----------------------•------------------------- <br /> JOB ADDRESS AND LOCATION____�T___ .__._..�� ,.- <br /> Owner's Name <br /> e.......f2Fjdfie...------- -------- - ---------------••---------------------------- Phone_l�.Int6..---- <br /> , <br /> f�l2.l <br /> Address-----•----- -----------------------•--•----'••------•--_-S---N----.----•--.•:•5--.�..•-a•---te---........----N----4•''•:-.-f•--•------•----------------- -----•----•------------------------------------- <br /> Phone./Y.0 <br /> --------------•-•----- <br /> Phone�� f?g6.E7 Contractor's Name--•-••---------.-� -'-� Q ; <br /> r ` <br /> Installation will serve: Residence Ej`�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ M <br /> Number of living units- ._I._.. Number of bedrooms __efi_. Number of baths ---/.. Lot size ---------/__�zc_ 4E--­-______-•_____________ ------ <br /> Water Supply: Public system ❑ Community system ❑ Private R Depth To Water Table _KK . ft. <br /> Character of soil to a depth of 3 feet: Sand ❑' Gravel ❑ Sandy Loam ❑ Clay Loam Ni Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date----------.---------) No D4 New Construction: Yes a No ❑ FHA/VA: Yes ❑ No 2 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: s <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well___.3_0------Distance from foundation----- ater�l----�__ __,_ _____________ , <br /> NNo. of compartments_____.:-A---------------Size__�6__.... Liquid depth-----`��__ -------.-Capacity__ ___E'a!?4-_ , <br /> Disposal Field: Distance from nearest welL__.,3__0......Distance from foundation.-__1n..'.r___.Distance to nearest lot line----- <br /> Number of lines--------------1-------------------Length of each line__ _____._%P_'-.--_____.Width of trench......_____�.3�_" .___.__.. _ <br /> ® _ <br /> Type of filter material....�ov_l<-_-_____Depth of filter material___-__fi _.j <br /> e_..-_..-_Total length---------------- <br /> Seepage Pit: Distance to nearest well---14M?.........Distance from foundation-----/& .."..._..Distance to nearest lot line._-:..f_...-__.._ <br /> NNumber of pits---------/__________Lining material----Wp-ate.--Size: Diameter-----.33- Depth...........2A7_'............ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material---------...______-.________.._...___ � <br /> ❑ Size: Diameter--------•-•---------------------------Depth----------------------------------------------------Liquid Capacity---------- -----------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------.---------------- -- <br /> ❑ Distance to nearest lot line-----------------------------------------------------------------......----------•-••---------------------••---------._...------------------- <br /> Remodeling and/or repairing (deseribe):________ ------- - � -r�--•------------•••••-•--°----•------- <br /> _.----•------------- <br /> -------------------------------•-••---•--------------------•---•---------------------•----------------------------------------------------------••------------------------------------------------•---- <br /> -------------------•-------------------------------•-•-------------------------------------------------------------------....-----•-•---------------------------------------'--------------------.-. --------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> no --- ----.-..52_ '--------------------------------(Owner and/or Contractor) <br /> r+ae f----------- ---- -------------- <br /> BY:_-------------- �------------ --------------------------------------------- ) <br /> (Plot plan, showing size of lot, location f system in relation to wells, building's; etc.,_car�be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- ` � <br /> DATE . <br /> REVIEWEDBY---------------------------- - • -- --------------- DATE <br /> BUILDING PERMIT ISSUED------------ -------=---------—------------------------------------- QATE-- --------- <br /> Alteration and/or , comr�endatio�r sem__ _ ''` -/=--•-------- ----•• 4 <br /> -------------------•-- ------------- ----------------------- <br /> ---?------•---------------------- ---t-- - - -- C----------------------------------------------- <br /> ------------------------ --------- -------------------------------•- - - ---------•------------•--•-••-------------------...------------------------------------------------------------...-•------••----•------- <br /> i <br /> FINAL INSPECTION BY: r ------------- ----- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srnet 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 8-59 2M 5-62 ATLAS !� ��'^- <br />