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rUrc Urtica uae: <br /> - - ._-------------------------------- / <br /> ...._ _. - _____ ------------------------- APMC:ATION FOR SANITATION PERMIIis"' Permit No. -.7440j <br /> - --------------------------- (Complete in Duplicate) .i��/� (� <br /> J <br /> ----------- --- ................ This Permit Expires i Year From Date Issued 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 compliant with County Ordinance No. 549. <br /> jt�-•L,.. /t <br /> JOB ADDRESS AND OCATION l - <br /> 2_7x -.-ILNf5(__.__-_ <br /> Owner's Name- - - ----- `------`- --------------- Phone.......------------------------ <br /> Address------ A - - ...... <br /> Contractors Name-- e - -- - -' - - - . Phone <br /> a <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: _1 l <br /> ___ Number of bedrooms _---_-_ Number f baths _-__-_ Lot size ___-_- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Joe ft. / <br /> Character of soil to a depth of 3 feet: $end ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay L—�/Adobe❑ Hardpan C] <br /> Previous Application Made: (If yes,date---_ --------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well._•�-_-_-__Dlstanceffrom � <br /> rfoundation_-_-_� _._-__--.Material____�C?.c�....................... <br /> No. of compartments-------- � 'q p, _ <br /> .J�.X �� x '��r LI wd depth >y- <br /> r i <br /> Dispos Field: Distance from nearest well�'C-..._._._Distance from foundation...../.D-__-___-.Distance to nearest lot line..__..... <br /> - Number of lines.--____.�__:.._..,_��jj-. Length of each line....../.dl.!_----+_..Width of trench----_._7 _____________ <br /> Type of filter material_. {!L_--__.Depth of filter material------- ...Total length..........if 0-40!-------­........ <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 /> _ pp� <br /> ❑ Size: Diameter------------------ - ------------------------------------------ - <br /> --- -------------Depth ---------Liquid Capacity----------------- i <br /> Privy: Distance ffom nearekt well..-------_--------------_--------------------Distance from nearest buildin <br /> ❑ Distance to nearest lot line------------------------------'-----------------------------------•-----------'----------_9*---------------------------------------- <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, S e ws, and rules and regulations of the San Joaquin Local Health District. <br /> r (Signed) - - p� - d/or Contractor) <br /> By _._. ....Cl..-.-.-... - ---------------- <br /> lees <br /> ------------- - (TiNe) ------------------------------ -- -- - <br /> (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). <br /> `e FOR DEPARTMENT USE ONLY <br /> L APPLICATION ACCEPTED BY---- =i --------------------------------------------------------- DATE- G�----- ---- ---------------- <br /> -- - - -- ----------------------------------------------- <br /> - - <br /> REVIEWED BY- -- ----- --- --------------_------ - <br /> -- ------ ------------------------------------------------------------ DATE.--------------------------......----------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------_---------------.... DATE-----------------------------------_------------_--- <br /> L Alterations and/or recommendations----------------`--- -----------------------------------------------------------•------------------------------------------------------------------- <br /> .................----------------------------------------------..-.....------------------...---------------------------- -------------........................................--------- -.....- ------ <br /> -------- ------------------------------------------ <br /> -------------`---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ <br /> ._....-- -------------------------------------------------------------------------------------------__----------------------- -.-- -........--------------------------------------------........... <br /> _ . <br /> FINAL INSPECTION BY:-. _/_�' 7'Lr- ......-.-.____ Date -/ <br /> f� " <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi,California Manteca,California Tracy, California <br /> CS 9 REVISEC 8-59 3M 3-'63 F.P.CO. <br />