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lie <br /> FOR OFFICE USE: „F- .R: <br /> f I APPLICATION FOR SANITATION PERMIT Permit No. ... . .. ....------------------ -' --- -----_.. <br /> ----- - --------� -- _ (Complete in Duplicate) Date Issued _-_•.-----Vi........ <br /> This Permit Expires 1 Year From Date Issued <br />-------------------- <br /> Application is hereby made to the Sari 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. <br /> -r <br /> JOBADDRESS AND LOCATION._-- -----------------•-------------•-.........------------=---••--........ -------------•- <br /> Owner's Name----------------------- ------------ j01M_-$1Mbgs.-------------------'----------- -=-- --- ••-------------••-----;-------._- Phone-A9......3-8 ------- <br /> Contractor's Name----b-The...DJAY----i..IJIT.GHT.__Sedt.ja-___T_ank---SSr-V#:C49-------•--.-..__-.--------••--•--- Phone----Ad---63.81f1---... <br /> Installation will serve: ResidenceU Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _....1 Number of bedrooms __2___ Number of baths ...1_ Lot size _-_---_.1.5(_).t----X---1Q9r-------------------- _ <br /> Water Supply: Public system x Community system ❑ Private ❑ Depth to Water Table _3.fleft. <br /> st <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ <br /> Previous Application Made: (if yes,date----------_---------y No ❑ New Construction: Yes ❑ No 'FHA/VA: Yes ❑ No,,❑ !� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) '.". . <br /> Septic Tank: Distance from nearest wellNorie-----Distance from foundation-------10______.Material__------ .-.--•-•••••_._.. <br /> No. of compartments___.__2-----------------Size....56!s.x3j6'!y------Liquid depth___-`72..:-___...-----Capacity-.J.000_111a <br /> Ir7 rM <br /> Disposal Field: Distance from nearest well---KOM_Distbrttce from foundation-.__1.r��t.......Distance to nearest lot line..___...... <br /> Number of lines-'I-----1----------------------Length of each line---------9fli--------------Width of trench------------ZV------------ <br /> --- <br /> Type of filter materia048lt::0_.RkDepth of filter material_________1911_ Total length.......9Qt___________________;._.-__ <br /> e-Pit: Distance to nearest well__NOIae--_______Distance from foundation___3_Q't-_____-bistance_to nearest lo# Gne................. <br /> t <br /> 6epag' Number of ------------Lining material.__�.E.lCk-------Size: Diameter--------3,�s---------Depth---------•---2a...it..... <br /> Cesspool: Distance from nearest well___:____-____._.Distance from foundation_______________-__.Lining material..................................... � <br /> ❑ Distance from nearest- -•------- ---------- Depth. Liquid Capacity gals. <br /> Size: Diameter___ r - Distance from nearestbuildin <br /> Privy: well------------•------- --------- ing----------------------------------•----- <br /> ❑ Distance to nearest lot line....-------------------:------------------------ ---------------••----- ---------------------------------------------------------------------- <br /> t <br /> Remodeling and/or repairing (describe):____* -E - - -- g-----rQ�+---h0u�e__.fr.Q Q...exjstj a S$.Gm._K� --------- <br /> a <br /> -__� � <br /> arat_jn f �•.- <br /> = k SO---each_-house--wild. base. irdexuiOz� - �3rsem� <br /> ------------------------------- <br /> ----•----•-•-----------------------'- <br /> ---- <br /> I hereby certify that l have prepared this application an that the work will Oe done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the S4 n Jo quin Local Heal District: <br /> (Signed)----`�'hei---DA.Y--&.-NIGHT:--S-ap-�_i.�---Tank--5.� f ,r s { �-Contractor) <br /> ---- ---------- Title---------- •--------------=----------••- --------1...... <br /> BY:------------------------------------------- --------------- (Title) <br /> (Piot plan, showing size of lot, location of system in relati n o wells,buildings tc., can be placed on reverse side). <br /> EPARTMENT USE O LY <br /> f ---------- DATE--------- -------•---- <br /> APPLICATION ACCEPTED BY--------- <br /> REVIEWEDBY-----------------•- ----- ----------------------------------------------------------------•---. - DATE:_-.-----------------------------------•-------------------- <br /> ec <br /> BUILDING PER IT ISSUED..... --- - -------- --------------- -- -------••-----•----....-------••-----------------... DATE...._...----------------------------------------------------• <br /> v <br /> Alteration/' / r 1 ommend'ation;: =-------- <br /> Lr�^'�-e <br /> X s _. :::.::.::........•---•------------- -----------------------------------------------­------- <br /> ---------------------_--- <br /> ---------- <br /> --- � _ <br /> -----------------------------------------------------•---•-----=----'--- -------- <br /> FINAL INSPECTION BY: -- ------------ Date_.. �� ... <br /> ------ <br /> r ________________ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i 130 South American Strout 300 Wool Oak Strout 124 Sycamore Street 205 West 9th Street <br /> 1 Stockton,California a Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 L-M 5-41 ASLA9 <br />