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FOR OFFICE USE: <br />---------------------------------- ---------------------- <br />----------- ........ ----------------------------------- APPO:�XTION' F'OR' SANITATION PERMIT <br /> Permit No. <br /> -------------------- ------------------------- (Complete in Duplicate) <br /> j <br /> ------------------------------------------- A This Permit Expires 1 Year From Date Issued Date Issued ..... 16 <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 with County-Ordinance No. 549. <br /> (0 i ;3 - - 0-3 <br /> J B ADDRESS AND LOCA N....S..L10.­-OZ-1-21L� <br /> -------------- lla,?7�_ ------------------_----- <br /> ....I------!_,� - * ------------------ <br /> Owner's Name_.._ 5- <br /> ........ -------- -- -------- --------­-------------------------------------------------------------- Phone._/,Z-:!d Z....... <br /> Address-------9,44.1......... -------i, <br /> 3--- ---- --- ----------- <br /> ....................... ----­­........................ ------------------------------------------------------ <br /> ;eM <br /> Contractor's Name-------- ------- ------4 .......... ................._...... Phone.......... ...................I----- <br /> Installation will serve: Residence C] Apartment House E] Commercial [I Trailer Court [I Motel Ll Other s L <br /> Number of living units: Number of bedrooms 3--- Number baths ]XxLot size ---------- -------- ---------------_ <br /> Water Supply: Public system ❑ Community system F]' Private Dpth To Water Table -------- ft <br /> Character of soil to a depth of 3 feet: Sand C] Gravel [] Sandy Loam [] Clay Loam 12� Clay ��Ado6e❑ Hardpan ❑ <br /> Prev'ious Application Made: [if yes,date....................l No ❑ New Construction: Yes [-I No El FHA/VA: Yes El No ❑ <br /> TYPE`OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool per'i4itted if public sewer is available within 200 feet.) <br /> Septic Tank- Distance from nearest well_________________Distance from foundation---------------------Material------------------------------------------- <br /> El - No. of compartments-------------------- -----Size__--------------------------Liquid depth-------- -----------.... Capacity----------------- <br /> Disposol Field: Distance from nearest well-.-,SA-------Distance from foundation_J.#.........Distance to nearest lot line...... <br /> Number of lines--------------Z--------------._Length of each line------/-&-o---- -------Width of trench.......- <br /> ?-------------------------- <br /> _�__Type of filter maferial___��----Depth of filter material------Zt Total length-----ZAjiP."' � I <br /> ------------------------ <br /> See aqg Pit: Distance to nearest well----10P---------Distance from foundation------/A?.1_..Distance to nearest lofline.�5_11------ 7-� <br /> Number of pits-----------/---------Lining material-_­�_�__ Size: Diameter_---.____ -------Depth----�_S------ ------------- <br /> %. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-_-----__--------_-.Lining material--.-----.__..-._----..__.-_-------1._ _ IM <br /> 171p Diameter--------------------------------------De pth-----------:Tt�-----------------------------------Liquid Capacity----------------------------gals. W, <br /> Privy: Distance from nearest well-----------------------I <br /> ------------------------- -Distance from nearest building---------------------------------- <br /> --­------------- <br /> 0 Distance to nearest lot line--------------------------------�f!----------------------------.......- --•-----• ----------- <br /> lm�g�an or repairing (describe):----------------- - ------------I------------------------------------------------------------------­------------------------ <br /> -------------------------------------------------------------------- ----------- -- ------------------------------------------------------------------------------------------ --------------------- <br /> ............................ -----------------------------------------------------------------:--------------------------------- -------------------- <br /> --------------------------w--------------------------------- ------ ------------------------------------------------------- ----------------------------------------------------------------- <br /> I he-re6y certify that I have prepAr-ed this application and that-the work will bedonein accordance with San Joaquin County <br /> ordinances, State laws, and rules a d regulations of the San Joaquin Local6Health District. <br /> .. ......... <br /> - -- ----- -- --- ----------------------------------------------------------------------------(Owner and/or Contractor) <br /> (Signed)--------------------­--7------------ ----------- - <br /> By:._----_-------•-------------•• --- ----- ----------- --- ------- ---- --------------------------------------(Title)---1----------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system�in relation t weiLls, 60dings, etc., can be pla'ced on reverse side). <br /> FOR DEPARTMENT,.USE ONLY <br /> ----------------------- <br /> APPLICATION ACCEPTED BY..1411- 0�42__�_ _ I------------- --------------------- DATE-----/_1". _ .y------ <br /> -- ------------------ <br /> REVIEWED <br /> ATE-----/Z ------ --------------------- <br /> REVIEWEDBY--------------- :f� ---------------`--.......----•------. DATE--------------------------- ----• --- - - <br /> BUILDING <br /> ATE-------------------------------------------------BUILDING PERMIT ISSUED----------------------------------------------:---------------09-------••---.-.......-•.----------- DA-TE:::t-------------------------------------------------------- <br /> Alterations and/or recommendations:,.-1.­-- ---- -- ------------- -----------I--=-----•---------- ...................................................................................... <br /> ----------------------------------------------------------------------- --------------­,_1------------------------------1­1­�---------------------------------------------------------------I.........­-------------- <br /> ---------------------------------­­------------------------------------------------------ <br /> --------- --- ---------------------------------------------------------------- <br /> ------------------------------------------------ <br /> I . .1 r.1. <br /> -------------------------------------------- ------------------- ---------­­------------------------------------------------------------------------------------------­­-----------­­---------------------------------- <br /> -----------...................................... ------------------------------------------ ------------------------------------------- --------- <br /> FINAL INSPECTION ---------------------------------------------------------- <br /> ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 2M 5-62 ATLAS <br />