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FOR OFFICE USE: <br /> --------------------- 'or-OR Permit No. <br />-------------------------------------------------------- <br />-�---"�"""�" ---_-""-" � _ ------------------- <br /> ----------------------------- <br /> _ APPLICATION SANITATION PERMIT / <br /> -------- --------- ------- ------------ ----- (Complete in Duplicate) Date Issued <br />__ ___ --------------- This Permit Expires 1 Year From 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 ap lication,is-made in compliance-with County Ordinance No. 549. ��cf -' �'���©� <br /> �" •-•--- <br /> JOB ADDRESS AND LOCATION._ �`-�""� ------��u---�-----��__`,-"--'" <br /> Owner's Name----G. _ Phone...-------•------------------------ <br /> Address - ---------------------------------- <br /> i• - -- --------- ------- <br /> Contractor's Name__.#1F6?%,w .....................................-.........------------------------------------•---------...__.._.__.-- <br /> --------------- <br /> Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ <br /> Number of living units: I------ Number of bedrooms .4--` Number of baths J-___ Lot size�_(l i,L- <br /> Water Supply: Public system ❑ Community system ❑ Private "Depth To Water Table _19.a. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ <br /> Previous Application Made: (1f yes,date---------------- No New Construction: Yes IN No ❑ 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.) ! I <br /> p - -.dat Li uidx---•-------.Material_. <br /> p tic Tank: Distance from <br /> } 11---S'--'-------Di t n e f < foundation_ depth_ �-------- ----- Ca aci -----•--"--. <br /> JcompartmentsQ ' <br /> No. of p <br /> M q <br /> Disposal Field: Distance from nearest well_r.7_".._____Distance from foundation_l__----------------Distance to nearest lot line_1............ It, <br /> f Number of lines------ --------------------- Length of each line-----9 -------""="- ---"Width of trench._2-'f."...------------•---..._ <br /> ------Total length---&q-- <br /> Type <br /> �.Ia_'.. <br /> Type of filter materials." ----Depth of filter mate rial_..- -?'-_____ ! <br /> Pit: Distance to nearest well_JIN___.-_____-Distance from foundation_..�'t___..._....Distance to nearest lot Gne_ _______________ <br /> �' Diameter_ ! . Depth..../_9- <br /> ------------ --------- <br /> Number of pits___:.--------------Lining material___:_-- -"-- <br /> Size: <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------.------------Lining material-----------------------------..els. <br /> ❑ Size: Diameter------------------------------------•-Depth-------- ------------------------------------------Liquid Capacity----------------------------9 <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building---------------I--------_----------------- <br /> Distance to nearest lot line----------------------------- ----------------------- •----...---------------- <br /> t I <br /> Remodeling and/or repairing (describe)----------------------------------------------- <br /> •-•-----•-----•----------------------"•----------"--------•------.----•-•--------•----------•----------.. <br /> 4 "___________________________________ <br /> ----------------------------------- <br /> -----------_------------------------------------------------_----------------------- ------------­---------I­­------------I-----------------------I-------------------------------------------I---------- <br /> __________ _ ___________________________________________•______-__________________-____._________-___...____._-__-______.____..___--.___._.__.. <br /> hereby ce ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta laws, d r les req lations of the San Joaquin Local Health District. <br /> (Signed) --- ------- -•----------------------- ----------------------------------------------•------------- ------------------------ <br /> ----------------------------------- <br /> --------------- <br /> --- ---- <br /> (Owner and/or Contractor) <br /> By:_ --------•------• --------------'--------•-•---= -------------------- -------------•----- --- - <br /> - -------(rifle) <br /> (Plot plan, 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 /> DATE__�3_ �f----------------------- <br /> APPLICATION ACCEPTED By: ---------- <br /> REVIEWED BY---------------------------------------------------------- -------------------------•-------------------- <br /> ---•-------------------- DATE-------•-------------- ---""---------•-•-------------------- <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------- <br /> ._•-------- DATE <br /> Alterations and/or recommendations----------------------------------------------- ---•-----•-•-------------•-----••-"--- • - <br /> -------------•--------••----------------•--------------... <br /> ----- -------------- - <br /> - -•---- <br /> -----------------------------------•"-- <br /> -----;e;- _- ---------0�jf <br /> ------------- <br /> -------------- <br /> -------------------------- <br /> FINAL INSPECTION BY. _.__.. ..- ----------- ---------- -- ----- <br /> SAN <br /> _. --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wert Oak Street 134 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 );,—, ___1 , ' <br />