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urrit-t ubt: <br /> ------------------- --------------------------- ---------- <br /> ----------------- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------I...... ------------------------------------- (Complete in Duplicate) 51TZ-t <br /> ---------------------------- --------------I-------------- •This Permit Expires 1 Year From Date issued Date Issued _r................ <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. r <br /> 0"' 1 MAN- EC-f+ <br /> JOB ADDRESS AND LOCAT_IbN. <br /> -------------- vis _t��,Kvv_aea <br /> Owner's Name <br /> --------------------- Phone_.TA9.-3::.j <br /> 1 <br /> _-- -- --------------- . <br /> --------- .33) <br /> Address.._ <br /> . . ........ <br /> ............. <br /> est 1ti 1 <br /> Contractor's Name.1V1_91qTEC,6 <br /> -------------­ PKonh................................... <br /> I',{ "31 1 ­ I,.,,41-\ 1,r1- -1 'A <br /> Installation will serve: Residence er Apartment House El Commercial E] Trailer Court [3-Motel '[I Oi6r`o <br /> e .......------------- <br /> Number of living units: j.... Number of bedrooms .3--- Nlu'mber of baths Lot •siz <br /> Water Supply: Public system [:] - <br /> Community system 0 PrivlaltAii 93"'Depth to Waf6ijible• <br /> Character of soil to a depth of 3 feet: Sand Qq- Gravel [] Sandy Loam 0 Clay Loam 0 Clay❑ Adobe❑ Hardpan <br /> -.Previous Application Made.-{If yes,date---.-_--_--------:t:--) NoNew Consfrtiction_�­Yrs A/VA:' Yes No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (N_* septic tank or cesspool perm-tWed if public sewer is available within 200 feet.) <br /> di <br /> Septic T nk: Distance from nearest well__50-----Distance from foundation_1 <br /> Er <br /> Pth_AZ V --------CapacityJ2.40.6"', <br /> No. of compartments---_2-- -------------Size.-Y-A-0-A-�L�.-Liquid de " ' -a_ ... <br /> < ZY- <br /> Disposal Field. Distance from nearest well---5!0--r---Distance from foundation----/ ---.....Distance to nearest lot line...S.�...... <br /> Number of lines-----------/----------------------Length of each ........Width of french-------362F----------------- <br /> Type of filter materiaI..._1?P.CJ_4�.__Depfh of filter01 <br /> material.::�Yf �f!Tdtal length-__----_---40 <br /> L. I - , J, .Q____________________ <br /> Seepage Pit: —jD isfance_to}nea rest well----------------------Distance from foundation--------------------Distance to nearest lot line._--_-__-._._-... <br /> -Number of Pits---------_----------Lining material-------------------•---Size: Diameter_---------------------Dept h------------- <br /> Cesspool: A; ---------_ <br /> f - --- <br /> `Distance from nea rest-wel i stance from-fourrdatiorf------—___ --.Lining materia <br /> ----------- <br /> F1 Size'; Diameter---- Dbpth------------------------------ <br /> --------------------------------- ------------------I.-Liquid Capacity------------- <br /> ---------------gals. <br /> Privy: Distance from nearest well _j!1'j <br /> --------------------------------- --------------Distarce from nearest building-----------___-_-_--------------- --- <br /> ------ <br /> ❑ Distance to nearest lot line----------- <br /> --- <br /> - -------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):_-_---_------------------ ------------------------------------------------------I <br /> ............................... ---------------- <br /> --------------------------------------------------------------------------------------------------------*---------------------*------------------------------------------------------- + <br /> ------------------------------Z--------------------------------- i----------------------------------------------------------------------------------I------------------------------------------------------------------- <br /> --------------------------------I---------I-------- --------------------_1------------------------------------------------------------- <br /> 1 hereby 19-ilify that I have re d ---------------- --­-------------------------------------------------------------------- <br /> pare accordance with San Joaquin County <br /> �, S Va 17n Ii,Ul ns of the SanlJoaquin Local Health District. <br /> ordinances, 'S a i(laws red rules apid r4o <br /> {Signed)_ - -- <br /> 44 <br /> ----- ----------•- -----------_-----------(Owner and/or Contractor) <br /> BY:--------•• T, ------- -------------------- --------­------------­ -----_------(Title)---t , - -- ----------------------------------------- -------------- <br /> (Plot plan. showing-s',ze -iy-�fi� iA-relation-fo i wells, buildings, etc., can be placed on reverse side)." <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__7T. __,_Ti:t43------ ------------------------------------ ------------ --------.. DATE-•----- =1 -� <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE---------------- <br /> BUILDING PERMIT ISSUED <br /> AJtera fiow$76nd/ok7re—co-mrrr,eFncrMi6-ns4- '—�--- ------------------------- <br /> -- -------­--------------- ...........--- <br /> ............... .... ..-- ---------*------------- ........ ----------------------- <br /> ---------------------------------------------------------------------------------- -Z�--------------- <br /> .........................I---------------­------------------------------------------------------- <br /> ------------------------------------­- -------- ------------ ft, 4 <br /> ----------------------------------------------------------------------------------------------------------- <br /> ---- -- - - ----- <br /> �W_/---------------------------------- ------- <br /> ­­------------------------------------------------ ------ Z <br /> ---------_. <br /> ­------­----­­------------------------------------------------------------------------------------ <br /> -------------------------------------------- ------- <br /> ---------- ------ ---------------------------------------------------------------------------------------------------­- <br /> 7�, <br /> FINAL INSP ON BY-' <br /> Date----------- <br /> SAN <br /> ate--- -------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> SlocklOnr California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5-59 2M 5-61 ATLAS <br />