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FOR OFFICE USE: <br /> -VX. /�3! <br /> APPLICATION FOR SANITATION PERMIT Permit No. ......�2_40.5 0 <br /> till <br /> (Complete in Duplicate) <br /> ---------------------------------------------- -------------- This Permit Expires 1 Year From Date Issued Date Issued ---V7,46--4, <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to con uct and install the work herein described. <br /> This application is made in compliance with County Ordinance No.,549...-. 1 <br /> JOB ADDRESS AND LOCATION..'L_�,5r-w- � _--_t 'c`��._., ____!� 23$1-60—Z/ <br /> '' '��-------------•---------•--------• ----•-•------•---•--_----••------ <br /> Owner's Name------------- ••... /1�195_gd-cl -------------------i------------------------------------- ---------- Phone-----•------------------•-------••- <br /> Address-------------••--------- �?fs l '� f'` ref <br /> Contractor's Name .rlce.0------------------------- ................. Phone... .:"-' l <br /> f <br /> Installation will server Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Mol ❑ Other ❑ <br /> Number of living units: __.j__ Number of bedrooms __.3__ Number of baths Z_-_ Lot size ______ ______ ___47. ------- --,___ <br /> Water Supply: Public system ❑. Community system ❑ Private Ir Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gj Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well _0---__Distance from foundation Tank: -_-_ ---.Material---. i <br /> I <br /> 1 <br /> No. of compartments__--______. -----------Size____: " Liquid depth__---__ _.__-......Capacity---- <br /> �, �r <br /> vL K �{�-�•-.� <br /> Disposal Field: Distance from nearest well-_7_,Q.........Distance ffom oundatjpn_ IA!! _- _-- istance to nearest lot line------.e. .__. , <br /> Number of lines-------_Z_ __---Length oir,a I�n�e � CjWidth of trench:_.._ f ________________ Ug <br /> Type of fitter.material-__l-t/.z.__-P-.&-,r-k.Depth,.of filter material------- -__Total length_. .. <br /> Seepage Pit: Distance to nearest well---------------------- from foundation---.----------------Distance to nearest lot line_• __-- '• <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----.------------------Depth-----.------------------ <br /> --- ---- <br /> Cesspool: Distance from nearest well-___________--_Distance from foundation---.-.----__-.----.Lining material--------------------- _________ <br /> ❑ Size: Diameter------------------------------------Depth----------------------------- ---- ----------------Liquid Capacity--------------------------.gals. <br /> -Privy:­- Distance fromnearest ___________„__._______'.._."Distance from nearest building____---__--__-_-_______________._.___._. <br /> ❑ Distance to nearest lot line---------r--------------------------------------------------------------- -------------------------------------------------------------------- <br /> 0 <br /> Remodeling and/or repairing (describe)-------------------------- <br /> ---------------------------------------------------•------------------------------------------------------ ------------•---------- --------------------- -------------------------------•----------------------- ------ j <br /> t <br /> ________________________________________________________________________________________________________________________6__________________________________________._-_.__._______________-_-___-_.-_._..----_.-----_--..--._ <br /> I hereby certify that I have prepared 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 /> t <br /> ------------ <br /> (Signed) ------- -------- ------- - and/cContractor -.By:---------------- � .. -------------------------------------- --------- -.------ -----(Title)- --------AIRA�wne <br /> ..------- <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 <br /> APPLICATION ACCEPTED BY------ --- --------------- --------------------------- -- ---------------------------------------- DATE ------------- ----------- ----------------- <br /> REVIEWEDBY------------------------------------------------- ------- ------------- --------- -------------------------------------- DAV <br /> - -BUILDING PERMIT ISSUED �DAT <br /> Alterations and/or recommendations:--------------------------------------------- ----------------------------------------- ------•-------•-------- -.--------•----------------------------- <br /> ------------------•-- -------•------------------------- •-------------------------- <br /> ----------------------------------------------------------------------- <br /> --------------------- --------------- I <br /> FINAL INSPECTION BY:.... - ---- = -------------- Date---------------- <br /> ----------------------------- <br /> SAN <br /> -------------- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California * Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.CD. - y <br />