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LICATION FOR SANITATION PERL.rf Permit No. <br /> .................. <br /> -------------- ----'-------------------- ........ (Complete in Duplicate) <br /> -- --- This Permit Expires 1 Year From bate Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to c str t and install the wQk herein de r ed. <br /> This application is made in compliance with County Ordinance No. 549. 2 <br /> JOB ADDRESS YNDLOATIO ._ __.�._0-`7--_ r� C.N "" -- _ -------- <br /> Owner's Name___ .-+..� Phon <br /> ` ---•------ _ - <br /> Address -------AfX67 <br /> -------------- .� <br /> - s _ -4 _..._r -- -------------------------- <br /> ` Contractor's Name_.._ > ------ f._ - �` I f 1 / <br /> -.-----------•-------- Phone. .: <br /> Installation will serve: Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._.____ Number of bedrooms _ __ Number baths ._I___ Lot size ..._.. `�� <br /> Z_. .. •-•-----••-- <br /> . Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table <br /> p __ t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> r Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No 9?;;OFOHA/VA: Yes ❑ No ❑ <br /> TYP. F INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> I k) Distance from nearest well_________________Distance from foundation__._____--______---.Material____-_________..______.._ _ <br /> Na of compartments ---.Size----------------------•-------.Liquid depth--------•-----------------Capacity---•--------------•---- <br /> i <br /> D s i cd»'-•� Distance from nea est well__ -. Q ...-Distance from foundation____/j Distance to nearest lot line....... <br /> Number of lines__.._____ .__. Length of each liner f/ <br /> 9 ��Q.----------•Width of trench.----- ----- � <br /> �{- Type of fitter mater -c _Depth of filter mate_•-__- <br /> ---Tota! length-- •------•---------•-••-----•,�_Q_ <br /> i r f ` .\ <br /> Seepage Pit: Distance to Weare twell--�_ F? --DistanceiTUndatiDistance to nearest lot line...-,F. 6k Number of pits_____ ______________Linin material__-g -- -Size: biameter_ �ft-."Depth--•--��f.-----•--Cesspool: Distance from nearest well __Distance fromundation--------------------Lining material__--------------------................ <br /> F4 ❑ Size: Diameter----- - ------------------ -----------Depth------------- -------------------------------------Liquid Capacity-- gals. <br /> t Privy, Distance from nearest well______________________ <br /> Distance from nearest building-_--_-.---.-•_-.-----•------------------ <br /> ❑ Distance to nearest lot line----------------- ----------------------- <br /> ----•---- ------•---- ----------------------------------- ---------- <br /> Remodeling and/or repairing ibe}-------------__ _ <br /> ----------- <br /> -------------------------------------------------- -••------------------ ----- -- -- - ------- <br /> ---------------- •------------------- •---------_ -1-- ------- ------ <br /> -- -- - -- ---- <br /> --•-----•-•-------- - - ------------------------ <br /> -------• ----- ---- <br /> ------ --- ---- - - ------ -- ---•----... - <br /> Ihereby certif Ilia rel red this application and that th ork be done in actor ante with San Joaquin County <br /> ordinances,�il aws, a rule and regu ' s of the San Joaqui ocal Healt istrict. <br /> (Sign ------- ---------------- -- - ---(� Contractor) <br /> t <br /> $y:----•-----•------------------ -------------F, <br /> : <br /> _ ---- ------ i le)-------- <br /> F (Plot plan, showing size of lot, location of system in rel on to wells, building etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_- <br /> - - DATE---="==----i•-�=---- -----=-------------------- --- <br /> REVIEWED BY-----------------------------•--"------------------------------------------------------------- .------- ------------------- DATE - <br /> BUILDING PERMIT ISSUED-----------------------J---------------------------­- DATE-------------------------- w <br /> Alterations and/ cecommend'ations:._---- <br /> -- ' -_--- ---_-- <br /> --••------- - -------------- <br /> ------- <br /> F-- < �f-r— � w `• ----------------- <br /> - - <br /> ­------- <br /> ---------------- -------------------- --------------------I—----------------1----------------------------------------------------------------------- <br /> .......... -------------------I-- <br /> ---------------- ------------------- -- --------- ----------------------------------------- -------------------------- ------------------ ------- <br /> I ------------------- .................. .. ............. ------------ <br /> ......-1--------- <br /> -----------------­---------------------------------------------- --------------------------------- <br /> FINAL INSPECTION <br /> ------- -- <br /> ------------ --------•-- Date------------------ <br /> SAN <br /> ---------- --SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Streat <br /> Stockton,Coul rnia Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 8-59 2M 5-62 ATLAS <br /> j <br />