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FOR OFFICE USE: <br /> --------------- <br /> 11 <br /> Permit No. .......... <br /> APPLICATION�'FO'R'%_ ANITATION PERMIT <br /> ------ ------- 7--------------------- (Complete in Duplicate)., - .�:" - — . ;TIA- <br /> - --------------------------------- - -- Date Issued :�Z/ <br /> -------------------------------------------- This Permit Expires I Year.From bate Isiu-ed <br /> permit'to construct and install the work herein described. <br /> ,A�pplicafion is hereby made to the Son Joaquin Local Health District fog a p 3 <br /> This applica.1to d in compliance with County Ord' ante No. 549. <br /> is made <br /> j <br /> JOB ADD LOC�TION------1//Z ------- ---- - -----------rL---- --------------------- ---------------- <br /> nce with Ty <br /> 1, C n Ord' a c" <br /> rAALC <br /> --- ------ --- <br /> ------ ------------------ -------- <br /> Owner's Na e <br /> --------------------------- <br /> -------------- <br /> Address__ ------------------- ----------------- ---------------------- --------- ------------- ------------ <br /> I <br /> __1----------- Pone_ -----_---------------------- <br /> .. ------------- ----------------------------------------- <br /> Contractor's Name__.__;_ --- <br /> Installation will serve: Residence Apartment House El Commercial <br /> ❑ Trailer Court:Z] Motel E] Other [I <br /> 0 <br /> s Number of'bath, Lot si <br /> Number of living units: Number of bedroom =------ ------------------------------ <br /> 71� <br /> Water Supply.• Public system 0 Community system El Private Eg__Rvp to Water Tabli. <br /> Character of soil to a depth of 3 feet: SandE] Gravel 0 Sand456'am ❑ Clay Loam E] 'Clay E] Adobe Ej-oflarclpan C] <br /> t�o�'t'�FHA/VA: Yes E] No <br /> Previous Application Made: (if yes,clate- ---- ------------ ) No U4,e New Construction: Yes [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - <br /> Septic Tank: Distance from nearest well----V--------Distance from foundation--/—a--- M f 1riiaI__X_d_rj C.f, <br /> No. of compartments----z-----------------Size. .._-fir/ ---------Liquid depth---- -------Capacity----- ---- <br /> t <br /> Disposal Field: Distance from nearest well- ------Distance from foundation----/.12--------Distance -to nearest lot line_.$7_ ------- <br /> Number of lines-Z I e7.0 -' ED <br /> --------------------Length of each line------Gla-r-------------Width--------------------Wid.;h of --------------- <br /> �ial -------------------------- io <br /> Type of filter r�,afe, of filter material....1-K. -------Tot, <br /> Seepage well_. -j. frorn-Joundafion--- ---------Distan&'to nearest lot line-------5------- <br /> "'Pif: Distance to nearest elL -_ - I - <br /> Number pits--------wl-----------Lining maferi-al--- Size! Diamef.r�3_3��_i......Dept ----------- <br /> j L,; :T - 0�j <br /> Cesspool: Distance from nearest well­7777:'!--------Distance from foundation---------------------Lining material-----------------------------------'. <br /> Size: Diameter------ Depth----------------------------------------------------Liquid Capacity- -------------------------gals' <br /> ------------gal V11 <br /> 171 0 <br /> Privy:; Distance,from...ne.zi-c.e.st-36�elI------------ ----------- ----------- Distance from nearest..building- <br /> -------------------------------------- <br /> , I I F ---------=. . % ___1------------------- ------- <br /> F1 ell� Distance 0 nearest lot4ne—_...---------------�_T�' <br /> ----- -------------­------------- ----------------------------- ---- <br /> 14 <br /> Remodeling and/or repairing (describel:.- v_ -4.re <br /> ',4 _n;i4_10------------------------- <br /> I- ---------- ------ <br /> IL -------�_ <br /> ------------ <br /> -------------- ----- ----------- ---- ------- <br /> I <br /> 'r�j &.7 <br /> - ------ ------- ----------------- ---------- <br /> - --- ----- ------- -------2 <br /> v-a-p-r e-p-a tired K is' plFclaric;4 and the work w' d done co ante with San Joaquin <br /> Ax <br /> I hereby certify that I work ike County <br /> ordinances. Stat ws, and and regulations of the San Joaquin Local Health District. w' e,J <br /> (Own and/or Contractor) <br /> (Signed' ----- ------- -- --- -------------------------- -- ------------------------------------------------- --- --- <br /> By:---------------------------------- - -------------------------------------------- -----(Title]-- ---- <br /> - - - ---------------- - ----:------------ <br /> (Plot plan. showing size Of lot, oc ion of system in relation to wells, buildings, etc., ;c. on reverse side)... <br /> FOR DEPARTMENT USE ONLY <br /> 1,E --- <br /> 1, goo DATE------ Al/_ ------------------------ <br /> APPLICATION ACCEPTED BY <br /> REVIEWEDBY------------------------------------------ ---------------------------------- -------------------------------------------- DATE---------------------- -------------------------il---------- <br /> BUILDINGPERMIT ISSUED---------------------------------- ---------------------------------------------------------- DATE--------- ---------------------------------------------------- <br /> il -- ---------------------- ------- ------------------------- ------------------------ --- --- <br /> Alterations and/or rec en ons --------------- ep <br /> ------------ ----------- -- `"------------- <br /> 2r_zw:!� <br /> ------------ <br /> ----- ------------- <br /> --------------- ------------------------------------------------------------------------------------------ <br /> ----------I------------------------------- -------- ----------- - --------------- ------------------------------------------- <br /> --------------------- ---------------------------------------------------- --------------- ----------------- ---------------- --------------------------------------------------------------------------------:---------- <br /> ---------- ..... -------- <br /> FINAL INSPECTION BY:- --- _.­AC,��------------------- Date <br /> -------- ---------- ------ T . <br /> -- <br /> - ------ <br /> SAN JOAQUINLOCAL-HEALTH DISTRICT <br /> re" 124,Sycarnore Street 205 West 9th Street <br /> 1601 E.Hazelton Ave. 300 West Oarst, at, 11, \ 1, - <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 SM 3`63 F-F-Va' <br />