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FOR OFFI, E. <br /> Permit No. <br /> � �„ � <br /> ... .. . <br /> APPLICATION FOR'-SANITATION PERMIT <br /> ................. ..... . ..... <br /> --------------I------------------------------------------ (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 application is made in compliance with County Ordinance No. S49: <br /> JOB ADDRESS AND LOCATION....-•--18-75-0. <br /> W.-- iaim..Stme.et.,-------------qtCLCkt_0n_.f--- AK------------ <br /> - --------.................. <br /> - KZQ[ <br /> I - .........�2a�3--------_- <br /> Owner's Name----------------L.e_0___Re;�.r.e_raL--------------------------------------------------------------------------- -------------------------- Phone <br /> Address--------------------------aaMe------ -------------------------------........................................----------------­--------------------•-•-----------.............................. <br /> Contractor's Name------The..D-AY---&.111GHT---Se-Ptic -erx-Ice----------------------­--..... Phone <br /> Installation will serve: Residence];a Apartment House `Commercial [3 Trailer Court [3 Motel C] Other 0, <br /> Number of living units:?--__-! Number of bedrooms _3--- Number of baths __-2___ Lot size ....., <br /> .......... <br /> Water Supply: Public system Eli]Community system 0 Private Depth TO Water Table .2Q'ft. PLUS <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel 0 Sandy Loom [I Clay Loam El Clay C] Adobe OK Hardpan 0 <br /> I No ❑ <br /> New Construction: Yes E] No K] FHA/VA: Yes <br /> Previous Application Made: (if Yes,dcite__/_j_S_j------ ) No ❑F­1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I r --------------------Material----------------------------------I......I------- <br /> Septic Tank: Distance from nearest well- ---------Distance from foundation <br /> E:Usting No..of compartments--------------------- ....Size--------------------------------Liquid clepth--------------------------Capacity------------------ <br /> Disposal Field: Distance from'nearest well-----------------Distance from foundation----_--------------Distance to nearest lot line_---.....__._.... <br /> Number of lines------------------------------------Length of each line-----------------------_-----Width of french---------------- ... <br /> - <br /> E93iting Type of filter material.------------------------Depth of filter material-------_--------------Total length-----_--------------•------------------- <br /> Distance to nearest well---'70Jt-----___Distance--------Distance from foundatiori-_110..........Distance to nearest lot line.... <br /> Seepage Pit: --- <br /> ting Number of pits---L2----------Lining material----Rock-------Size: Diametee-4--t—x_ ------I'Depth---------- <br /> R(C -- — 4�'a"NP'X/Oferial----------------------------­ <br /> Distance from nearest well-----------------Distance from founclatkon!------------------ ining Ma <br /> ❑ Size: Diameter.--•---------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------_----------------- <br /> Distance to nearest lot line------------ --------------------------------------------------------------•--------------•-------------------------------------------------- <br /> ❑ <br /> Remodelingand/or repairing (delribel:----------------------------------- ------_-------------------_------------------------------------------------------------------------------------ <br /> ----------aW _T NA, ----------------------------------------------------------------------- ------- <br /> _PLa1Z]b -ARY...I&A-T - JGF------------ <br /> ---------------I-------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------- <br /> I <br /> I hereby certify that I have prepared this application and that.+he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and ruiet'and regulations of +he SanjJJ quin Local Health District. <br /> L <br /> S v --------- -------------(0N;PP;AX1Ar Contractor) <br /> (Signed)--------1�4q DAY NIGHT Septic Tank S ..........­ <br /> . . ..............(rifle)--------------------------------------------- --------- ...... <br /> BY:_-------------------_--------------------------_--------------- ------------------ <br /> we Is <br /> etc., can be placed an reverse side). <br /> (Plot plan, showing size of lot, location of system in relation o wells, building <br /> FOR DEPAATMENT USE ONLY <br /> APPLICATIONACCEPTED BY------ ---- ---- -------- ----------- --------------------------- ----------------------- DATE-------- ----------------------- <br /> REVIEWEDBY------------- ------------------------- ---------------------------------------------------------------N-----------------., DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------- —-------------------------_---------- DATE----------------------------- <br /> Alterations and/or recomIrVqnCrations:-------- - - - -------­--------------------r*,--;7---------------- --------- _T�f_ <br /> ...1.4 .x- - ...__.... ------------------------- <br /> -------------------------------------- -A----L -- ---- -- <br /> . s - - " Y.,9------------------------------------------------- ---------------------------------------------------------------- <br /> -------------------------------------_------------------------------------------- <br /> IT ------------------I------------------------I------------------------------------------- ---------------------- <br /> ------------------------------------------------------- ------------------­­-------------------- ------------------------------ <br /> ---------------------_----­-­------------------- -------- ..... 9---------------------------------------------------------------------------------------------------- <br /> rr <br /> � Date------------- ------ <br /> FINAL INSPECTION BY-_. ------------------------------ <br /> ---------- ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak STreet 124 Sycamore Street 205 West 9th Street <br /> stocktom,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />