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FOR OFFICE USE: <br /> --------------- -- -- ------------------- <br /> APPLICATION FOR SANITATI Permit No. <br /> ............ ---------_---------- --- -- ------ 0 IN'ED imis ""t"'"G' <br /> ................. <br /> - ---------------------------------- (complete in Duplicafell, <br /> ------ - --- ............. ----------- This Permit Expires I Year From Date ssu.7 <br /> I pplication is hereby made to flus San Joaquin Loeol Health District for a permit to construct and install the work herein described. <br /> �is application is made in compliance with County Ordinance No. 549. <br /> co` <br /> 1C-1V_1cr 1.4 <br /> JOB ADDRESS AND LOCATION--_---------__----------___41�_Pm? . ........ <br /> Owners Name------------ ------- --- ----- .--•--•--------- <br /> Address--------- ----------------- <br /> Contractor's Noma-----•--- ..... --------------------- Ph9ne..ZZ2.-. -/ 4 <br /> hartallation will Serve: Residence W Apartment House [] Commercial 0 Trailer Court 0 Motel 0 Other 0 <br /> Number of living units: .._..__ Number of bedrooms Number of baths .-/.. Lot size ..... <br /> Wafer Supply: Public system C] Community system 0 Private [XI Depthro Water Table &12- ft. 0 <br /> Character of soil to a depth *13 feet: Sand 0 Gravel 0 Sandy Loom a] Clay Loom 0 Clay 0 Adobe C] Hardpan 0 <br /> Previous Apprication Made: (if yes,dote--------------------I No [in Now Construction: Yes [] No 0 FHA/VA: Yes Ej No [:1 <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---_......-----Distance from foundation....-,--.----......Material......... .................. <br /> 11 No. of compartments_-------------_____...Size-_.-----_----._-----.-.Uquid depjh........_................Capacity..................... <br /> Dis;;lXeid: Distance from nearest 3._.._Distance from foundation._-./-4-'--.-.Distance to nearest lot <br /> Number of lines-------------- __._.__.___-..Length of each line.____--_Q','-,---.Width of +rench__..2..L.............. <br /> Type of filter material----ka-C.ff_.-Depth of filter material.--- ....Total length........�5­0....................... <br /> Se Distance to nearest well----_1_0.4------Distance from foundation.._!___Distance to nearest lot <br /> Number of ------Lining materia1_..,&_-iCA<---Size: Diameter_sS--------------Depth___/Z--- ............. <br /> Cesspool: Distance from nearest well..............._Distance from foundation...----------------Lining material._._._....._....-_...-..-........ <br /> ❑ Size: Diameter-----------------------------------Depth-.--_----------------------------- ---------Liquid Capacity..---------- <br /> 00 <br /> 11411-15, -----------11 � <br /> vy: Distance from nearest well._-..__.__.....___________.._ �___ nca from nearest ....... <br /> Distance to nearest lot line.------------------------ ------ ----- --•----•--•--_� <br /> 0 <br /> Remodeling and .. .... <br /> ------•__-._--_-••------•-•-•--------- <br /> - <br /> -----------_------------------------ <br /> ............ ....... <br /> H.r -------_----------------—--------------- <br /> -------------- --------_----- ----------------- ....... ----------------------------............................................. <br /> that I have prepared this application and work will be done in accordance with San Joaquin <br /> ac <br /> ordinances. o aquin Local Health District. <br /> (Signed)------6.111 Iflal�v _--- .-4_4 _4' _� e <br /> le � A . -_,e ---_erl _7 - ------------------------------------(Owner and/or Contractor) <br /> -- --------------- <br /> By:------- -----------­ <br /> ow.---- - ---------------- ----------------------_------ <br /> (Plot plan, showing size of ""tion of system in relation to walk, buildings, efc-, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- T --------------- .------------_-------------------- DATE--- ................ <br /> REVIEWEDBY...._....... ................------------------- _---------------------- ----------------_-------------------____ DATE-----------------------------*-*-'-"-"---•------ <br /> BUILDINGPERMIT ISSUED- ----------------------------------------- ------- ----__...._---....................... DATE---------------•-------•----------------....... <br /> Alterations and/or recommendations:.------___--_--___-. - ------------------------- <br /> .......... ----------------­------------ --------------------------------I----- ----- ----------------­-----­--------- --------- <br /> ­ ... ..... -- --------------------------------___---------- ..........---------- ­ �--------------- ­­------------........................................................... <br /> .........................I......-•----------------------- -- -----�_---)---------------------------------------*------------------­--.------•----------------- <br /> -------------------------­-­-----------• <br /> - <br /> - -------------------------------------------------------------------­----­-----------------11------------ <br /> �.FINAL INSPECTI N BY Date......... ...5_17_-_,6579-............................ <br /> ----------I------------------­----_---------- ---- ...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 So.th American Street 300 woot Oak st'"t 124 Syconeve Street 205 West 9th Str"t <br /> Stockton,California L*44,California Manteca,CalfforrAo Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />