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d— d <br /> ............_....................._.----------.-- APPLICATION FOR SANITATION PERMIT, r Pa"n"o. <br /> ........ ............... - --- ---- (Complete in Duplicate) - d �-j/ // <br /> .------- This Permit Expires 1 Year From Date Issued' DiihilAssued ....../...._r.163 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to con truct and install the work herein described. <br /> �is application is meds in compliance /w/ith�ounitjy' Orddiinaance No. 549. !� c6-� �^ �,_-s eel jepg/ <br /> JOB ADDRESS AND LOCATIOff_...ill.rt_.ti1/.._.ti2�. . _---- ±!)L--/ .-.._ ...F?? ✓ .7/.L:. ....... <br /> .Ga_lGxf. <br /> Owners Name...................- - l- ...........:7 4_4`4.,"- ------ ----- ------ - Phone......._.._...... <br /> Address..._....- ...-- - ' jc._ sem_ . sz ..---- .- <br /> _--.-_ <br /> Contractor's Name.../� / / /y ........... PI oned 4/1._..7 / 7(ca <br /> L<$�c.d-i+.f a.-....��er...G�-_L..-Q.nG.a--�-F6------------......................__..._.. .-..-..-...—/.— <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial e Trailer Court ❑ Motel ❑ Other ❑ /I e7ar'/F>�r <br /> Number of living units: -------- Number of bedrooms------- Number of baths ........ Lot size -. ............_.........s77,W <br /> Water Supply: Public system ❑ Community system ❑ Private 2r"Depth To Water Table !�O ft. <br /> Character of soil to a depth of 3 feet: Sand [[Gravel ❑ Sandy Loom ❑ Clay Loam❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Ilf yes,dote--------------------) No,B'_New Construction: Yes or�No ❑ FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool parini if public sewer is available within 200 feet.) // <br /> Septic Tank: Distance from nearest well._..�{.T.�_,Distance from foundation..../17... _:.Material.._ ac.>.r ............... <br /> 0' No. of compartments........ ...........Siza.,3�59X.s.'......,-.Liquid depth.......;K..�.�_._.Capacity...A20.6AI <br /> Disposal Field: Distance from nearest well---Sp_'Distance from foundation...Ze. ....Distance to nearest lot line... ..... <br /> ®� Number of lines.__..-._....(..............Length of each line_..............-...........Width of trench.......�..............__... <br /> Type of filter material.'4Vz,j----..__Depth of filter material..--%�.'_._..Total length...........XL.`?-.�._...._......... <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 /> l ❑ Size: Diameter-----------.............-----------.Depth--........................... .............Liquid Capacity..........................gals. <br /> �Fivy: Distance from nearest well---------------_------..____----,------ ------.Distance from nearest building.................... <br /> �._....,.... <br /> ❑ Distance to nearest lot line_----------------------__---------- ------.............................__-__--------------_,----..--...,.._.......-._._ <br /> Remodeling and/or repairing )describe):__ -------------------------------------------------------..._..-..- --.-_ ..__....----•----__..-_..___..___._,... <br /> `-----------------------------------------------'............................................--...,.................................-.............-`-•-..........>...-........................._................ <br /> .... <br /> I 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 /> (Signed) - _ tea- :, _., _jam.�r r�-- -/a/Jy,!/' ---- ------------....--------------------------------.............(Owner and/or Contractor) �1 <br /> By:------. .e. 5 ..... GfL .........fl.---I----------------------- ........ ..... I ;*f±c.,.---& aC...Rya.. .- . . '`1 <br /> (Plot plan, showing size of lot cation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTNT USE ONLY <br /> APPLICATION ACCEPTED BY.__ .,lt a m__.__....._.. DATE-_._ _^...G� ............... <br /> REVIEWEDBY...................-._......................---------------_ ;/---------_------- ---------.................. DATE.-__­­­""....... ........ <br /> ATE---•---__------- ,,......- _....... <br /> BUILDINGPERMIT ISSUED-----------_---------------------•-----_----........_..................._.........I...... DATE_--.....................--------......------- ...- <br /> Alterations and/or recommendations:----------_--_-------- ---- .................___--------------_...................._._--._....._............................_ <br /> -.........- -------------------------- --------_------------------------------------ ----..........­­..............--.......................--_----------------------`- -...... <br /> - -----.....----- ...... . -- - --- --------R - --------....................-----------.........................._................._---...... ...._.. . <br /> FINAL INSPECTI - - - - Date a------_------------_-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stroot 300 West Oak Street 124 Sycamore Stmt 205 West 9th Street <br /> Stockton,California Lodi,Coliforria h9aniesa.California Tracy, California <br /> ES 9 REVISED B-59 2M 5-52 ATLAS <br />