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FOR OFFV IJ�SE: <br /> Permit No. .._/r] <br /> APPLICATION FOR SANITATION PERMIT f <br /> 1/ <br />....:......... c <br /> (Complete in Duplicate) <br /> ------------------------------------------ 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 wor herein described. <br /> This application is made in compliance-with,County Ordinance No. 549.. V& Al P!� <br /> � <br /> JOB ADDRESS AND LOCATION__Z_2_1_ <br /> m -_ .. ..�.----- -------- -l.l C P �/ <br /> Owner's e Q PhQ <br /> dCj <br /> Address. --Aj_TL0-•--F---- .�z S... c h.�11.. 11r4~ i�l --- -- t ...0_ t--------------- <br /> ---- A ----- -rte- - ------._.: _rem Phant •-{�-.. � / <br /> Contractor's Name__. .. .#� .- -4- � �' <br /> Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other [r <br /> Number of living units: ___ er of bedrooms -------- Number of baths . _ Lot size ._/ �y - ------- .......�-- <br /> Water Supply: Public system Community system ❑ PTivate ❑ Depth To Water Table �ft. <br /> Gravel Sand Loam ❑ Clay Loam ❑ ay dobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ ❑ Y <br /> Previous Application Made: (If yes,date--------------------) No F1 Now Construction: Yes No FHA/VA: Yes ❑ No [:1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public segter is available within 2( f <br /> Mater" 1----4-S:— •. -*. <br /> Septic Tank: Distance from nearest well__JAQ�--__Distance from foundation__ a <br /> No, of compartments-Z-1-------------------Size_�_.?C �- _-_...__.Liquid depth_. --... - --Capacity............. , <br /> Disposal field: Distance from nearest well_./ ---------Distance from foundation•__f� Distance to nearest lot line._..... . I <br /> Number of Length of each line�_0-------------------Width of trench.----�--$C!J--•---....__ "� <br /> Type of filter material _Depth of filter material____/ `,'_--Total length--�lp-l--_-------------^r•N <br /> Seepage Pit: Distance to nearest well/__e7!__`--____Distance from foundation___. _...--.Distance to nearest lot line------ <br /> Seepage <br /> W ' <br /> f Number of Its--- 3- - ----•-Depth-----2 -4"-••-------- <br /> r\ . _________Lining materlal_.�,rc�t______.5ize: Diameter____ ___ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--_._.-.__._--.____.Lining material...__-__--_.__.-..__-__-._____-...__- <br /> _De th----------------------------------- - ' ------Liquid Capacity--------•----- gals. <br /> ❑ Size: f}iameter----------------- -------- --------- -------- <br /> p <br /> Privy: Distance from nearest well -________________________--------_-----_-------Distance from nearest building___--.-___-_--_____...._____•-__.---_--.-. <br /> ❑ Distance to nearest lot line------------------------------ <br /> Remodeling and/or repairing (describe: ----•-- ---------------­-- <br /> ----••-•------------- --- <br /> ------- ---------------- - <br /> --- <br /> sL��- ------ --.. � -""� — <br /> y n <br /> _ �----��=� -. ' ------ --- ---- <br /> I hereby c lfy that I have prepared this applica+io and that the work will done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joa ' Local Healt District. <br /> 1 ---V-4-11 ---_---(gp�'onfiractorJ <br /> _A� <br /> ------ ----------- - ---•----(Title)------------------------------------------------- -------------- <br /> By:--------------------------------------------------------- ------ -- -ells, ildin s g tcPlaced on reverseside). <br /> (Plot plan, showing size of lot, location of system in relation w ., can 6e , <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------�� ------ --- ---------------------------------------------------- <br /> DATE..----- ------:------•---- <br /> �. REVIEWED BY--------------------••---------------•----------------------------------------------•-----------------•-----------------•--- DATE- --------------------------- <br /> BUILDINGPERMIT ISSUED------------- ------------:-- --------------------------- DATE.----------------------------------------------:------------ <br /> Alterations and or recommendations:__.=__%L = _ � '"' -y " <br /> Gam--cC---- <br /> � ,/��a ` <_P <br /> _ <br /> . j � �* --------- -- <br /> l ' `-`�^ `_`- c� ---------------- ter `------------------------------------------ <br /> - ----- <br /> , sit C <br /> --------- <br /> - . <br /> l ----- -- - -J- -- - <br /> FINAL INSPECTION BY:--- ---------------- Date---------7:( --- -------------------------------------------- <br /> 3- <br /> -••---------------------------------------- <br /> AN J AQU LOCAL HEALT 0ISTRICT <br /> 130 South American Street 300 Well Oak Street 114 Sycamore Street 205 West 9th Street <br /> . Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />