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--------------------- --------- - ------------- - a ? <br /> ---------_---__----_----, ,r1LICATION FOR SANITATION PENT Permit No. <br /> .--------- 1. ....SL. ..(... <br /> ------ -------- --------- -------- (Complete in Duplicate) <br /> Date Issued <br /> This Permit Expires 1 Year From Date Issued <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 Ordinance No. 549. E <br /> JOB ADDRESS AND AT19N._LC t A t 1 tick - -`-- --- - K -- - - t <br /> Owner's Name.... X - - .... ---------•- �-----•----- - Phone - -- <br /> Address------------- -- ------ <br /> Contractor's <br /> -- -- <br /> h -----------------------------------------.............. <br /> Contractor's Name........................------- . --_ �=�' --- Phone-------•----- -- <br /> Installation will serve: R dnce ❑ Apartment House Commercial Trailer Court ❑ Motel Other ❑ <br /> E . .rhe <br /> Number of : _._.l_. Number of bedrooms t_�-Number of baths ....--- Lot size ......-------_1 �:-A_-•------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private WI Depth to Water Table ..A�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[ / Hardpan ❑ v <br /> Previous Application Made: jIf yes,date--- -----------._.-) Nod._ New Construction: Yesj3} No E] FHA/VA: Yes [I No�] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �� <br /> (No septic tank or cesspool permitted if public;ewer is available within 200 feet.) <br /> Se pty Tank: Distance from nearest well-_.t. c.._._Distance frg, foundation__. _.-..____-:Ma lal_. ....-...__ __.... <br /> I�`j{�, No. of compartments..__: %...._.._.....Siza_.: :_X_ .x.."1/_----Liquid depth__._ . -,�----Capacity: -- -�---- <br /> Disp. osyI Field: Distance from nearest well-----6 ✓l._ .Distance from foundation__.__.,_gU...Distance to nearest lot/line_._:A___..__.. t <br /> Number of lines._..._I_______........___Length of each line____.._7f._----71---.Width of trench... .`{._,Z/-._______....._ <br /> Type of filter material_y i-I Depth of filter material------t[_...___-Total length...-._..V-4,....-.-.............. <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---------------------------galls. <br /> Privy: Distance from nearest well.___..._____-_-_...._.._.-------------------Distance from nearest building ...... <br /> ❑ Distance to nearest lot line------------------------------------------ t------------------_...-----------------------------------­­----- ...._...- <br /> Remodeling and/or repairing (describe):----- ...........__------------------------------------------------------------ <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. r <br /> (Signed).'/�K il�.r_!.ti l d/[i`-•--(_- -------------------------- - - ---------- -'--------- (Owner and/or Contractor) 1 <br /> By: -------------------....................._--- t------ -----.....-----------------------------------------------.._.(Title).- - -- - --- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------_---------------- --- ---------_------. ..... ......................... � DATE------------------------- -: 'r'------------ <br /> - ...........- - - ... ----- <br /> REVIEWEDBY-- -------------------------- ----- ----------- ----.. --------------------------- / - DATE},). ---1��--:_1 - <br /> BUILDINGPERMIT ISSUED-------------------------------------- ...................-------- -------- DATE._...---------------------------------------------------- <br /> Alterationsand/or recommendations:----------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- <br /> -------------------------------------------------'--------------------- -----------------------------------------------------------------------------------------'--................-...............------------------- <br /> -------------------------------------------------- <br /> ------ .... - ------ ----- ----.. ---------------; - --— ----------------- ---- - - -- -- - <br /> „ 'J Date._.-----1..�--J--`---C---- -- --- '--------------._. <br /> FINAL INSPECTION BY:-----------------.----. ------- y-----t--- - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi,California Manteca,California Tracy, California <br /> [5 9 REVISED 8-59 3M 3-'63 r.R.c D. <br />