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FOR OFFICE USE: <br /> *21-,L-------------- <br /> ;7 ------ APPLICATION FOR SANITATION ,PERMIT Permit No. .....L.�Q_f.k.._ <br /> ------- - --------------------- --------- --------------. <br /> (Complete,- Date.Duplicate},,. . � <br /> --- ---------=•---------------- <br /> This Permit Expires 1. Year From Date Issued <br /> 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 cpmpliance with County Ordinance No. 549. <br /> � Q <br /> JOB ADDRESS AND LOCATION__ 0 ----.98D-�--------��--- �f��---�`"� " <br /> 14 / o -3` °� --- <br /> Owner's Name .� _ C -5------•• ---- --- !' - Phones " / <br /> Address----------------`" 7,-7.�_1__ -e.-S- leot�L ..-----------------------------------------------------•-••---------------------------------------------------------------- <br /> Contractor's Name------------- P- . <br /> !_iek_s_h....._Tlv-��__. Phone.Cl_� -la�� _... <br /> installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer- #t )Z Motel ❑ Other ❑ <br /> Number of living units: ____.Number of,bedroomscx;-Z-_- Number of.baths . ___:Lot size -__-_--_�1 -..-__-_-__.-_ <br /> Water Supply: Public.system ❑ Community system ❑ Private Depth to Water Table// t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ <br /> Previous Application Made: (If yes,date------ - ';`'1 ,No m New Construction: Yes No ❑ PHA/VA: Yes ❑ No ❑�� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:' t <br /> t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> g,S <br /> Septic Tank: Distance from nearest well__S�-------Distance f�/ _ __ � <br /> rom foundation__._A�__Q__.---_.Mat ial-. . ..---- �--------------------- .� <br /> No. of compartments____ .�-------------Sizeez!_'_!S ______Li Liquid de th_--- R!-!---------Ca acit _l4�01�,9j'- <br /> Disposal Field: Distance from nearest well_4�-------Distance from foundation-Q -------Distance to nearest lot line-_---'�-�___ <br /> ' Number of lines----__.-_ar---------------------Length of each line_,'_--_�a�__-.Width of trench.-..----__�j./-�- <br /> Type of filter Depth of filter material -_,/_2__....._..Total length:-------� ------------------------ <br /> �Q_`_ Distanceom foun <br /> _._____ rdation___. d_�_._..Qista�ce to nearest lot line... <br /> Seepage Pit: Distance to nearest well,/ Z <br /> Number of pits_.___ `_ Lining material -_..Size: Diameter_ .. ..._..Depthf I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining ------------- <br /> El <br /> Size: Diameter--------'-----------------------------De th----------------------------------------- ---- ------Liquid Capacity gals, I rr <br /> !( Privy: Distance from nearest well---------------------------------------------.--Distance from nearest building------------------------------------- <br /> ElDistance to-nearest lot line------------------------- -------------------------- ---`------------- •--------------------r---------------------------------------------- <br /> Remodelin and/or re airin describe C� �= 1�--------- D- !--..+�•-�__-----��� ---------------------------- <br /> ,e } 9 / P 9 I ):---------/ <br /> -- <br /> ------------•-----•--------------------------------------- - ---------------------------------1 .�,.�-------=--_---------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------�---- -------------------------------------------------------=--------------------•-------------------------------------------------------- <br /> -� <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, tate ws, and rules and regulations of the San Joaquin LoU Health District. <br /> 01 <br /> f �('fj?�S .- F -------------------`------------ (Owner and/or Contractor) <br /> '(Signed). -------- _ _ <br /> I B p f f (Title} s ------------------ ----- <br /> y:------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buiEdings,"etc.can be placed on reverse side). <br /> f <br /> t FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY----.-- 1 # G•3 <br /> - - - - -`' '_.-- ------------------'---------------`------ DATE----�" ------------ ---------------------------------�`� <br /> REVIEWEDBY------------------------------------ -- --- ---------------------- ------- -------------- t--------------- ----- DATE------------------------------------------------------------ <br /> D PERMIT ISSUED---------- / --------- s - DATE---- <br /> Alterations and/or recommendations:____ _ ---�-�_.=�.��� __ c _ '------ ------< ---� ------------------- <br /> ----- --------------------------------------- ----- - ---------- <br /> #'`• <br /> --------------------------------- ............... - ------- ;------ ------------------_-- ------- ----------------------------------- - <br /> - - -- -- <br /> • *4 € <br /> ___1. ----__--..-,_-_-_-__- <br /> ------------------ <br /> ----------------------------------- <br /> ------------------------- <br /> ._ -------------------------- <br /> -____-_.__.-..------- --__.-_ ---_.__.___.._ ------- <br /> ---- <br /> ..___...-_._---..-----------..-.---.- <br /> r / <br /> -L/rJ�` ___ _________________________________________ <br /> FINAL INSPECTION BY:_ ---- --- -- -- ---- Date - :. <br /> SAN AQUIN CAL HEALTH D'ISTR <br /> i <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 3M 3-'63 F.P-C O. <br />