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FOR OFFIU USE. JJ <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. .,l-57.. <br /> --- -- ---- -- --- ---- <br /> t<� ete in Duplicate)� Dete Issued __�_(Compl <br /> _..�- -•- 7� <br /> This Permit Ex ires 1 Year From Date Issued <br /> A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo k herein described. <br /> This application is made in compliance*with CountV20 <br /> inance No. 549. E r <br /> ; �o �f - 4L_<_---�-- <br /> J08 ADDRESS AND ATI ! <br /> -------------- <br /> Owner s Name_____________ _______ <br /> ----------•------------•-- -----•-------------- ----------------------•-----•••_;� <br /> 01 <br /> --- •-- •--_..._�.-_... -•--- [�C <br /> --------------------- --- - <br /> Address______.__-•-- � _ Phone_.-- -� --- <br /> . °� �_�--+-------���----••------------•-------•-Motel ❑ ❑ <br /> Contractor's Name.__ f----- Other <br /> tion will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ r <br /> Installs .......... <br /> Number <br /> -- Number of baths _ __.__. Lot size ._. <br /> Number of living units: __1--.. N�+ber of bedrooms -- Depth To Water Tablet,: • f+• <br /> Water Supply: Public system Community system ❑ Private ❑ p <br /> Sand Loam ❑ ..Clay Loam ❑ Clay ❑ Adobe Hardpan❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Y ANA; Yes -] No ❑ <br /> Previous Application Made: (if yes,date--------------------1 No ❑ New Construction: Yes ❑ No ` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material_._____________________ _ -------- <br /> -_.----•---• <br /> T— pistance from nearest -----Distance from foundation_______________ Capacity <br /> No. of compartments______________________ <br /> --.-Size------••------•---------•-------L;quid depth---•----------------- _-------------------- <br /> No. <br /> -•----------•---•--.. <br /> 6 os ie Distance fro <br /> m Barest well==----------___Dis Distance <br /> of ea <br /> ch line ation......... ...:Distance tofttrench <br /> est lot line_----------•-...- <br /> / �.-� Numbed,;of lines-------------•---- 9 " <br /> `T Type of";filter mate -------------------------Depth of filter material------ <br /> length_.----_---.--..._...--•----•-----`•-- <br /> �. _ ..Dista c to nearest lot line.,�-•---•- <br /> Seepage Pit: Distance to nearest well__ d►� ---Distance f=erry foundation._ Depth_C> 0•------•- <br /> ---Linin material_K�?----- ---------Size: 'Diameter_ ------- <br /> Number <br /> .---- <br /> Number of pits'_...----_-.__-- 9 _ <br /> i Cesspool: Distance from nearest well:_----------------D;stance fro foundation__."_______________Lining materia_---"-------- --•-"gals. <br /> -­_-Depth----------------------------------------------------Liquid Capacity -" 0 <br /> ❑ size: Diameter-.-------------------------- <br /> i t---Distance from nearest building------------ ----------- <br /> r Privy: Distance from nearest well----------------- ___-__-._."- <br /> --------------------- --"-----------•--------�------------- <br /> ❑ Distance to nearest lot line-...--.-_._____---__---- 1 r � <br /> ---------------""--...--•----------------------------------- <br /> Remodeling and/or repairing (describe): .. ---- - <br /> ---- <br /> -------------------- -- <br /> -------------------------•-- <br /> ------------------------------------ ----------------------- - <br /> 1 hereby certify=that l h � pared this application and that the work w; a done in accordance with San Joaquin County <br /> ordinances, Stat rules and regulations of the San Jo <br /> les Local Health District, <br /> t <br /> con i actor) <br /> 5i nod) / y - <br /> (Sig 9 )----- ------ ( -------------------------------------- --- ------ <br /> -... - _ (Title)__ <br /> - ---------- p <br /> (Plot plan, showing size of lot, location of system in relati to wel{s, buildin s, etc., <br /> can be laced on reverse side): <br /> OR DEPARTMENT USE ONLY 01 <br /> APPLICATION ACCEPTED BY---------------- ---- ----- -"------ <br /> ----------------- DATE...----- f" <br /> - -------------------------------• DATE-------- <br /> -------------- -•-----•------------------ <br /> REVIEWED BY----------------------------- DATE <br /> BUILDING PERMIT ISSUED------•----------------------•-------------------------------•------------------------•-------- <br /> -.-. <br /> --- <br /> ------•-------••------------------------------- <br /> ---7---------------------------- <br /> Alterations nd/or recommend'at' s:-- --- ---------------------- ----- •- --- r <br /> ------ - <br /> � ,� ... ---------- --------- " <br /> -- --------------- ------------• --- <br /> ------ --- <br /> ----------------I----------------- -------------------------------------------------------- <br /> ------------­1------ <br /> ........------------ ------ <br /> ---------------- <br /> --------- -- <br /> ------------------------ ------------------------ <br /> ECTION <br /> Date--------------- <br /> FINAL INSPBY..... ---- --- -�-�T---�--------""---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 124 Sycamore Street 205 West 9th Street <br /> 130 South American Street 300 west Oak Street <br /> -• <br /> Manteca,California Tracy,California <br /> Stockton,California Lodi,California <br /> E5 9 REVISED 8-59 2M 5-62 ATLAS <br />