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FOR OFFICE USE: ," <br /> ` <br /> •-------------------------- <br /> '7 , <br />------------------------------------------------ AOPLICAT ION FOR SANITATION PERMIT Permit No. <br />--- ----------------------------------------------------- <br /> (Complete in Duplicate) <br /> Date Issued ..f...�.7.�- <br /> This-Permit Expires I 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 ein described. <br /> This a.p licatio-nn is made_in_ ompli_ance with County Ordinance No. 549. -� <br /> JOB ADDRESS ATION__ j_ <br /> - �- --- - -- p--- --- �.� - --- - -- - - - -----rJ o <br /> Owner's Na e- ,t,! Phone ... <br /> ----- .. <br /> Address-- ��.................I W:77'- ru°,1�--.-1�.11 p.- ••q a .. <br /> ----•---- ------ <br /> Contractor's Name. .. .... .... ... _ `t rci Trailer Court Motel Phone. Other � <br /> Installation will serve: Residence artment House` Co e ❑ ❑ er <br /> P ❑ ❑ � i <br /> Number of living units: .j. Number of bedrooms Number of baths ---4. Lot size .......� 7_ - .,___---.--•-.-_------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ........ ft. I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y Loam ay Loam ❑ Clay ❑ Adobe❑ Hardpan C1Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No—#t— Yes ❑ No ❑ ) <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _ <br /> (No septic tank or cesspool permitted if public sewer is available w within 200 feet.) i <br /> I <br /> �I <br /> Septic Tank: Distance from nearest well®_- _..Dista from �ound n.,_/0_______.MateIial. <br /> No. of compartments Size... 3 �Li uId depth, _ Ca au <br /> .� <br /> p q , P tY....- <br /> Disposal Field: Distance from near well______._Distance from foundationr,.. ..Distance to nearest lot line ..__.. a <br /> Number of lines--____ ___ Length of{echIf'ne�s�' e �/V�dth of trench----_-i _ ��__........ Qt�� <br /> Type of filter material� [._-Depth of filte material___ ______.__--.Total length__---_--I_�- � Q <br /> Seepage Pit: Distance to nearest well-----------------f-_-_Distance from!oundation.........---------•.Distance to nearest lot line.---__--__------. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------Depth--.----.--.------.--------------- <br /> 4 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----__---------_----_---.----_----... <br /> ❑ Size: Diameter--------------------------------------Depth---------- ------------------i=-------------------­ <br /> Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distancetirom nearest building------------------------------------------ <br /> I <br /> ❑ Distance to nearest lot line_:=------------------------------------------------------ ----------------------------------------------------•--•---------------- <br /> Remodeling and/or repairing (describe) .... .... ....... ---------- <br /> f -------------•-•----•----------------•--•--------_--- <br /> . 5 <br /> _________________________________________________________________________________________________ ___________________________•----_-___-_-----•_•----___--•--__--------___---•_--_-_____-. <br /> I hereby certify that I have prepared this application and that the work ill be done in accordance with San Joaquin County <br /> ordinances, S to laws, and rules and regulations a San Joa Local ealth District. <br /> (Signed)_.A - r ---------- Contractor) <br /> By:-------------------------- ............... ---- •--- ------ --- ------------ <br /> - (Title)-=--------------------.----------------- -------------------- <br /> (Plot plan, showing size of lot, location of system in r n to wells, buildir , kC., can be placed on reverse side). <br /> F DEPARTMENT-USE ONLY <br /> APPLICATION ACCEPTED BY._ ` �= '------------------------------------------------------------------- DATE- "L -----± <br /> REVIEWEDBY----------------- ------------••---•-•------- -------------------------------------------------------------------------------- DATE---•----..-..-------•--•--------------------------------- , <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------------:-_-------------------- DATE--------------------------------- --------------------------- <br /> Alterations and/or recommendations:----------------------------------------------------------------------------------- ----... ...-------•--•------••---------....-------------------•-----•-- <br /> ,.Y <br /> :----•---------------------------------•------------- - --- - ----------------- -- --------- -----------------------------•-•-----•----------------------------••-•----------------------------------------- <br /> ----------------------------------- ---------- --- - ---•-- ------------- ---- <br /> FINAL INSPECTI :� w Date `. ' '^ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Strut 144 Sycamore Street 705 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California - <br /> ES 9 REVISED 8-59 214 5-61 ATLAS <br />