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FOR OFFICE USE:'. <br /> --------------------- <br /> -------------------------------------------- <br /> --- Permit No. 1.` - u - <br /> .. - �f� -_ � �f--- APPLICATION FOR SANITATION PERMIT - <br /> ' --------- (Complete in Duplicate) S? <br />------- ------------ ------------ ------------ Date issued L--- � -- <br /> _.---•"_-_--_______________:--.-_. This Permit Expires 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 work herein described.' <br /> pP y <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----' /7----------- .............................................................................. <br /> Owner's.Name--• /�4re_C'4A........ .�' .0.. .Q__--_--------------------------------------------------- - --••----------•--• Phone../-/ <br /> Address---` �'S i9rriE a - -----------•-------------------------- ----•----••-•-----•-•••----••-••-�--•---....----••......--- ... <br /> Contractors Name 0.4 ` Q-_ R�2_�5,H-----�4QAA :------- - -= <br /> ....... Phone-l-la.6fd6�`----- � <br /> Installation will serve: Residence []' Apartment House [I Commercial [3 Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __L. Number of bedrooms _'�-_ Number of baths _L__ Lot size _.._7...,i�...-Y...l0142..'------------------------- <br /> Water Supply: Public system I] Community system ePrivate C3Depth to Water Table ----- f- (� , <br /> Character of soil to a depth of=3 feet: Sand ElGravel F] Sandy Loam a Clay Loam ❑ Clay ❑ Adobe ff"'Hardpen ❑ <br /> Previous Application Made: (1f yes,date.-------------------) No [r 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.) 1 <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-----_.`-----------Material------------------------------------------------- (� <br /> ❑ ��XlsTin+B No. of compartments--------------------------Size---•--•-------------------------Liquid depth--------------------•-----Capacity------------------------- <br /> Disposal Field: Distance from nearest well -- Distance from foundation---------------------Distance to nearest lot line................. i <br /> 53 E�OA a Number of lines-----_-_-1---------------------Length of each line-------20......-----..- .Width of trench......._2. .. <br /> 1 ------- .-------_. I <br /> Type of filter material.-.- A<------.Depth of`filter material _--/ --- ---_-.-Total length---------------1W-------------------- <br /> Seepage Pit: Distance to nearest well--/ylZ _Distance from foundation----Zo..-- -------Distance to nearest lot line---/Q._'----- <br /> Number of pits-------/------------Lining material-_.. -----.Size: Diameter----__33--"-------Depth-----2-S--_'----------------- <br /> pDa s <br /> Cesspool: Distance from nearest well_-_----_-------Distance from foundation--------------------Lining material.-._-------------------------------- <br /> f <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity............................gals. <br /> Privy- Distance from nearest well--------------------------------------------------Distance from nearest building-__----..------.._•-.---._-------.-------. <br /> ❑ Distance to'nearest lot line--------- ----------------------- -----•-----------------------••----------------------....------..._..------•--------•--•----------•-------- <br /> Remodeling and/or repairing (describe):-:-:-----.-- AP------- /4/,s.1/IWj!F----_-; P_....._.J. ------ 'aC.T. n.---------•---------- <br /> I -----------------••---- -------- <br /> --------•----- == <br /> -- ----------------------------------------------------------•------------------------------------•-------------------. •------------------------ = ....................... ......... <br /> I----• - ---------------------------------------------------------•- ---------------------�-------------•--- -= <br /> I hereby certify that I have pfepa�ed this application and that the work will be done in accordance with San Joaquin County , <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> '� iffaE' !•,f" �ClkCl' .7,4-C.--••--------.•-------••------ •-------------------- ----------(Owner and/or Contractor) <br /> {Signed)--------------`�:-:-- •--- <br /> By� x.. -- - ----------------------------------------------------(Title) - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY." - . <br /> - DATE f ,� f :---- <br /> REVIEWEDBY...-----•----._-- DA, TE------------------------------------------------------ <br /> dTEBUILDING PERMIT ISSUED--------------------------------------------------------------------------•- - <br /> Alterations and/or recommendations:---- ---- ------ ' <br /> --------------------------------------------------------------------------------......... <br /> ----------------- -------------------------------•---------------------------- <br /> L ---- -----------•-`---------••---------------- ----------------------------- <br /> lh­� date ---- <br /> FINAL INSPECTION'BY:-.-./,t-".. <br /> -- k � , <br /> SAN JOAQUIN LOCAL--HEA-LTH DISTRICT <br /> 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ED 9 REVISED 8-89 2M 5-6t ATLAS <br />