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�� rvrt �rrlc.t USE � � <br /> '---------.,--------------------------------..------------ I APPLICATION FOR-SANITATION PERMIT Permit No. ..,l....�`y..y.��-- <br /> ----------- -------- ------------------------------------ [Complete in Duplicate) <br /> I= -----------`------------------------- --------------- This Per Ex fres 1 Year From Date Issued Date issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permitern� <br /> and install the work herein described. <br /> This application is made in compliance with County Ordinance No. S49. <br /> JOB ADDRESS AND LrPCATION.Yi p l ��� -A\1f�1� y� `. _r._l T <br /> Owner's Name.. -------------------4-i- one.....----------------••............ <br /> 7--- --- 1.s.I - . <br /> ------------r� - <br /> Address_---•---•-• --`at-••--•.B .k--.....__ t1I-------- > � <br /> Contractor's Name........Q ...•------••---_- - Phone <br /> ---------- ------------- -------------------- ---------- <br /> ................................... <br /> Installation will serve: Residence F Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __`.... Number of bedrooms <br /> ( 1 __ tuber of baths ........ Lot size --�-y/�__�`___1--...�,.1�--------------------- <br /> Wafer Supply; Public system ❑ Community system Private ❑ Depth to Water Table .L?.___ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> -Previous Application�Made:-llfyes,date -No"tr—New-Construction: .Yes 55,-N-o-❑ FHA/VA: Yes ❑ -No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' r <br /> [No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S' ptic k: Distance from nearest well.-SO Distance from foundatio ° Material_____ <br /> No. of compartments-____ - ._..____SizeS.X_�_�_�iquid depth________ ____ _ Capacity CJ <br /> I. P ty-----a�... ••. <br /> Disposal field: Distance from nearest well_ __.._.Distance from foundatio __6®__.....Distance to nearest lot line--_�.__-�.�.. � <br /> Number of'lines___4_.- _ ___----------------Length of each line..__ Width of trench___--__ a <br /> IAr <br /> �— <br /> Type of filter material.. ___Depth of filter material..___s Total length.----- _. _--__•_ <br /> Seepage Pit- Distance to nearest well----2S-------Distance from foundation__,---_-__.Distance to nearest lot line_.._57_ <br /> Number of pits-----2-----------Lining mate rial_ROr,K----Size: DiameterYXL2X--------Depth------ <br /> _____..._._ <br /> ----------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-------.------------------. <br /> ❑ Size: Diameter------ ----------- ------Depth-----------•----------•-----------------------------Liquid Capacity--------------------------9 als. <br /> Privy: Distance+from nearest well____________________ __:____.-___._Distance from nearest building <br /> ❑ Distance to-nearest lot line--- •-------- ---------------- <br /> Remodeling and/or repairing (describe}:--------------------------------- <br /> •------•--------------------------------•----•----------•------•---------------------------------•-----------••-----•--•-•- <br /> ------------------"I------------ <br /> I <br /> ----•----------•--------------------------------------------•-----•--------------------- ----------•--------•- ---•------------••----•-----•------------------------------------•--------------------- ---------t=-f-------- F <br /> I hereby certify that I have prepered this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St laws, and rules and regulations of the San Joaquin Local Health District.14 <br /> i <br /> t <br />--.(Signed)-`": - ( / t ) <br /> . --��-- -------------=------ T _ � ._-_._. ner n <br /> ------------------•-------------=----�_-•--T'itle--------.._..-----Ow---•--.......or�Con`c or --�-•-r...r <br /> B ' ----------------•-••• ( t <br /> (Plot p , 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.------ ---- -, �.-C� -------------------- ------- --------------. _ DATE__ <br /> REVIEWED BY .... <br /> BUILDING PERMIT ISSUED= DATE '== <br /> •------------ ---• <br /> r------------•---------------------------•---------------------------------------.. DATE------ <br /> Alterations and/or recommendations;-i----------------------- <br /> -------------------------------------- <br /> .... __... " _'_ _s�oZ--------1�1Q.A11'.�------:TrA Ik-ant .kQCf�T7!?�11L 7- C— ?� Q.............`" I <br /> I <br /> - <br /> ----------------- <br /> -•-•.............. .--- -••------ ..... [ <br /> __.._ --------- ............. ------- <br /> f <br /> FINAL INSPEC BY: <br /> Date t �_ —_46" --­i--------------JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak$?rest 124 Sycamore Street 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California- <br /> r.. <br /> 90 9 REVIS£a $•59 2M 6-61 ATLAS s � <br />