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VI lut 0 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..2212-7. <br /> This Per (Complete in Duplicate) Date Issued ---- <br /> 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 wTtVhounty Ordina. ce No. 549 <br /> JOB ADDRESS AND ATION, 17___ - I t <br /> ------------------------------------------------I...... <br /> Owner's Name. <br /> .i <br /> .... ...... ............... Phone.._.....-.......-----..........---- <br /> .................................. <br /> Address........ <br /> T <br /> . <br /> Contractor's Name. -1- . . .. . ...................... ......... <br /> Installation will serve: Residence [I Apartment House E] Comm9rcial El Trailer- rt 0 <br /> Motel ❑ Other 1 <br /> Number of living units: ------.. Number of bedrooms Number 'ot 6f bath ..... o size ...1;2�� &.V�__ _ --............... <br /> Water Supply: Public system (:] Community system &prlvate epth to WatE r Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gral7e-ra Sandy LoAm Clay Loam E] Clay E] Adobe I] Hardpan I-] <br /> Previous Application Made: Yes E No �ew Construc itm,, F6A-/V.,A—YA 0 No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 set.) <br /> Septic Tank: Distance from nearest well.................Distance from foundalign.W.- i ........�Materlal_.P,22w.�.----- <br /> No. of compartments...... <br /> ----- -__---s i,4k4(K._-7,-.�k_KL4q 6 id .....*- --------C'apacity.-LZ <br /> 9, . <br /> Disposal Field: Distance from nearest well.__-_---------_Distance from foundat;6n.... .............Diitance to nearest lot line <br /> Number of lines-------_._1_Z------ ---..--.Length of each line-_ 16- ......l ---......Width;of trench.__- ................. <br /> Type of filter material-- Depth of filter material'...... ......Total length---__-- .......... . ............. <br /> Ir <br /> Seepage Pit: Distance to nearest well......................Distance from foundati6n........-----------Distance to nearest lot line..._-._._---___. <br /> ❑ Number <br /> ine-----­-------­ <br /> Number of pits-------..............Lining material.-....---------------Sizd: Diameter.......-_......._..._..Depth_....,_--,_.__-_...-_....._,.-_-- <br /> Cesspool- Distance from nearest well.................Distance from foundafipn...... .............Lining material.-.-----__--_____-____-._...._._.__... <br /> r7lSize: Diameter---------_---------------- .........Depth-----_---------------------i_...................Liquid Capacity-...........................gals. <br /> Privy: Distance from nearest well..............................................Distance from nearest building.__...---------------- ......... QST <br /> ❑ Distance to nearest lot line........ . -------------------------- <br /> ------------------------- <br /> P <br /> re <br /> Remodeling and/or pairing (describe):.............•---......--...-•----... ---•-•-••-----__^1._......_..._... ...................------------------- <br /> -••--•-•-----•........ •...........................................------------------------------------- ............................... .................................­............................. <br /> ....... <br /> jr-t--%%e, <br /> ................................ ............................­­--------------------------------------------------....... ....... j --- ......... ...-------------------------------------------- <br /> ........................._------------------------------------------__----------­------------------­­......................9­­-----------­---- -----------­---_-------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will.he dome ir,accordance with San Joaquin County <br /> ordinances, State laws, rules and lations of the Sari Joaquin Local Health District.egu, <br /> (Signed)... <br /> By:-------------------------------------------- ----------------- . .. ............­_­___---------- ................. <br /> (Plot plan, showing size of lot, locati relation _Engs, etc., can be Paced on revefse side). <br /> ................7­ A ner and/or Contractor) <br /> 2­-�------- ----- 1...... -.(Owner <br /> on-C4-S��e n f � S.- 4�, <br /> FOR DEPARTMENT USE 6NLY <br /> APPLICATION ACCEPTED BY_,;?�.... . .............................._....................................... DATE..--_. .------- <br /> REVIEWEDBY---------------------------------------------- ------- <br /> ---------- DATEF--------------------------------------------- ------ <br /> BUILDING PERMIT ISSUED------------------------------------____-------------------____----------- ------------------- DATE--------------__ - ----- -----------------------(�� <br /> Alterations and/or recommendations: _0F...... ".1L ------_1� <br /> ------- <br /> ......... ... ...... fi<5;��F <br /> .... <br /> ------------...............—................� F. ........ ................ .......................... ----------............................................... <br /> n-- <br /> -------- ------------- ­- --------- ------ -----------*­­--------------------------------------------------------- -­*------------------------------- <br /> .. ............ <br /> FINAL INSPEC Date-.. . 7 47/✓................... ................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 W40 Oak Street 132 Sycamore Sfrea+ 814 North "C" Str9of <br /> Stockton, California Lodi, California Manteca. California Tracy, California <br /> ES-9-2M Revised 8-'59 F.P.Co. <br />