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1 FOR OFFICE USE/ <br /> -- - A—A <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> in Du rcafe <br /> (Complete p ) Date Issued <br /> ..............................__..-------...____-. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin.Local Healfh District for a permit to cvnstryct and install the work h rein described. <br /> This application is made in compliance with Coun i e os <br /> l <br /> JOB ADDRESS AND ----...ffl??�,C<tK/�t�--/� ---- &.. . . ......... ' <br /> Owners Name. �/1-_ 1 ----• .. ._................................................ <br /> Phone---- -.................. <br /> Address._.]..=5��� , <br /> i <br /> r............................................................................. <br /> Contractor's Neme{ ." :_: -- - -- Phone..._....................------••- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court `9'Motel ❑ Other ❑ \ <br /> Number of living units: ._'._'__ Number of bedrooms -------- Number of baths -------- Lot size -./......................................................... \ <br /> Water Supply: Public system El Community system ❑ Private �epth To Water Table 6Mf+ I: <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑❑\ <br /> Previous Application Made: (If yes,date.. --- ------ -....) No � New Construction: Yes Z4-*r4o ❑ FHA/VA: Yes ❑ '.No ��-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if public sewer is available within 200-feet.) �,r< <br /> Septic Tank: Distance from nearest well----Sp__..._Distance from fodndatiol�. .lr�_.____ ai_.L�� .�'�_a <br /> Mate <br /> No. of compartments........,./_................Size � l� ~ {quid depth_c.�..4: .-......Capacity-.2040. <br /> Disposal Field: Distance from nearest well.`�a__-.._Distance from foundation:_. . <br /> 4e <br /> Number <br /> to nearest lot line.4 _...•.... <br /> Number of lines........'........ _ . _.�Length of each line__.___.-_..``... �� Width of trench.. -.-.._._>............... <br /> tType of filter materlal.4— Depth of filter material t—AZ- -------Total length... ..../ate...................... <br /> - V <br /> Seepage Pit: Distance to nearest well.__..f��.__._Distance f.r//ppm �foyyndotion....:r/Q.__...`D'is+a�ce to nearest lot % <br /> Number of pits.__.p�r..__.._._...Lining materiel../G fr�l�F__..Size: Diamefer._..� __........Depth._.e2,a----- ________________ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation._.:_ :'. _:.._.Lining material....----------------------------------- <br /> El Size: Diameter--------------------------------------Depth---------- -------------... ._.. ........--------Liquid Capacity----------------------------gals, <br /> �Privy: Distance from nearest well...................------- ------------------------Distance from nearest building,�...................................... <br /> ❑ ; Distance to nearest lot line- -._................. ------------ ' .• ............................................................ Y <br /> Remodeling and/or repairing (describe] :`_`... . -------- - ----------------­............................. <br /> ----------------•-•-------------------- <br /> .� , s-- ...................... <br /> --------------------------------------- ,I , i I <br /> ...................... <br /> 1 t 1 <br /> ________________------------------------______________—--------------------------------------------------------_._.__-..._.___.-.__...._.__-._.._-.---_-_-_._..______________-__—__-____---__._-__._....__._........ <br /> I her -rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rulesa, ulations of the San Joaquin Local Health District. <br /> =---------- -- ---- ...........:.......... r Contractor)- �;- <br /> / .(Signedl-.................. ----------------------- ---- ( � I <br /> . thezr�/ r ............... <br /> (Plot plan, showing size of lot, location of system in relatio o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY Cr <br /> = = DATE. 7.. ✓. .. .. ...................ACCEPTED BY........_."_�_. --- - <br /> v s .«e r-- ;.i.- -------------- DATE..........--•----- ---- <br /> REVIEWED BY----- ---------------------� -.. ..... ..........------------------•---..._--•-•-------• - -----------....--•-----••--•--- <br /> I BUILDING PERM IT'ISSUED'- - ••-•-•----------.•----=---------- 1.-----..........X. DATE.------...........--•--------- .. <br /> Aheratyons nd/or recommendations:.... -_... ! .-......-- <br /> r3 . ._ %............., .. ......-......-_.-------------•-----.---•- •-••--- .-•-.--•--- <br /> r - ' <br /> ' _......_._ _. ..... ........ <br /> -------------- --- _.. ..._.....___.__.____........................ ­--------------......... <br /> __.. _._�..Y.. <br /> 7fa_� her` =, jf_..- <br /> ._---------- ---- --------------------- <br /> f <br /> FINAL INSPECTION BY:... i Date. � <br /> _ "f ;Z_7/ � <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT . <br /> 1 130 South American Street 300 West Oak Street 12 4 Sycamore Street 205 West 4th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> £S 9 REVISED 8-59 2M 5-62 ATLAS <br />