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FOR OFFICE USE: <br />-------------------------------------------------------- APPLICATION FOR SANITATION PERMIT to Permit No. .__... <br />-------------- (Complete in Duplicate} <br /> Date issued . . . .............. <br /> ------------ This Permit Expires I Year From Date Issued <br /> I install,the k herein described. <br /> ii-he'r6loy made to the San Joaquin Local Health District for a permit t construct anc <br /> Application Z <br /> p6i afi n is <br /> This a made in compliance with County Ordinance No. 549. //,,Z <br /> 1110:S:4i,;1A:_V_1?tn�'- V <br /> .6 <br /> —JOB—ADD'K'ESS-AND LQCATI N_0 <br /> Phone.................................... <br /> Owne4_Name-----------le7 'I <br /> .........------------------------------------------------------------------------------ <br /> AddresulL.-- .........av Phone----------------------------------- <br /> Contract6t'�--t,lame--------4.,WAI <br /> ? . . ..... <br /> House ❑ Commercial o Trailer Court 0 Motel o ..Other [3 <br /> tio—w RAsidence IM Apartment Hou <br /> • Installation '"11 serve: j <br /> 'L*............................... <br /> Number of living units: .-L--Number of bedrooms --9-. Numb L or of baths A_- Lot size <br /> t Community system 0 Rrivatekq Depth to Water Table ft. <br /> Water Xup"ply: Public system 0 o a oHardpan <br /> CharaJUWof soil to a depth of 3 feet: Sand 00 Gravel 0 Sandy Loam 0 Clay Loam 0 Clay ❑ Adobe o <br /> ft—- I_-1 11, New Construction: Yes M No E] FHA/VA-. Yes o No El <br /> Previous,Application Made: (If yes,date--------------------) Nox <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> from foundationq___1-9 Material__..b,--- .....Z ......... <br /> Septic Tank:-' Distance from'nearest well____..._____-_Distance <br /> 3ants---1�--------------------Si,,__r- ------------I—Liquid clep�h-----q-------------------Capacity.... .......*........No. of compartm _ ---- <br /> n Z11 ..........Distance to nearest lot line__..__.___.. <br /> Disposal'Field: Distance from nearest well--.-_..___--------Disfanc.e,from foundafio h-----1-��" i <br /> Dq Number of lines-----I------------..-- Length of each line!7!f6jQ_77::77........Width of franc ---- ---------------------- <br /> -------- - ofal length.6-to <br /> Type of filter maferia to(-Depth of filter material-----14----------T --------------------------------- <br /> "07 <br /> Seepa 'a Pit Distance to nearest well----------------------Distance,from foundation....................Distance to nearest lot line__---___....___-- <br /> 9 J____.Depth--------------------------------- <br /> ---------------- <br /> L] Number of pits..-------•-----••-----Lining material Size: Diameter---_---------- <br /> Cesspool: Distance from nearest well-----------------Distance�f'rom foundation-------------------.1-ining material____-___.___-_____..____---.___....._ <br /> .. �- Size: <br /> aterial------------------------------------- <br /> Size: Diameter------------- -----------------------Depth------------------•----------------------------------Liquid Capacity-...........................gals. <br /> Privy: c. Distance from nearest well_________________ -------.--------'---------_Distance from nearest building------------------------------------------ <br /> Distanceto nearest lot line------- ----------------------------------------------------•-----------.-----------------• - -----------------••------------ <br /> Rem 9doling and/or repairing (d6fiCribe)-.__X <br /> ........ <br /> --------------n------------------------------------------------------------------------------------- -------------------------- -----------................ <br /> - <br /> 'fes - ----------------I---------------­--- ­ - ----- ­ ­------------ --I ------------ <br /> - <br /> ---------- ------ -------- ----------- ----- --- <br /> --------I.-hereby.-certify.- __that- - I have__prepared. - -__this-is-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 /> WOW, (Owner and/or Contractor) <br /> (Signed __44f�4- ------------- <br /> ----------------------------------- <br /> -------------------------------------------------(rifle)---------------------------- --------------- - --------------- <br /> By: location of s-stem-_in-_relation--- to wells, buildings, etc., can be placed.on reverse.-side)i <br /> (Plot plan.-showing.s a of lot, y <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> j�4 — <br /> DATE.__ "_3 ------i----------------------------- <br /> . ......... ------------------ DATE------------------------------------------------------------ <br /> REVIEWED'BY------------------------------------------------------------------------------------------------------------------------•--- ------- DATE------------------------------------------------------------- <br /> BUILDING7"PE"RMIT ISSUED--------------------- __------------ ..-...... ------------------------------------------------­......... <br /> Alterations and/or recommendations:-----------------------------------------­--------------•---------••------- ---------------- <br /> .............................------------------------ <br /> -- ------­-------------- -----------------------------------------------------------------------------------------------------------------------........... <br /> --------------------------------------------------- <br /> ------------------------------------------------------- ------------------------­------------­ ----------1 <br /> ----------L-------- -------------------------------------- ----------- <br /> --------------------------------------------------- <br /> ------------ ............................................................ ---------------------------------------------------------------------------- <br /> ------------ ------------------------- -------- <br /> - ---------------------------------------------------------------- ------------­--- <br /> ---------- -- <br /> ----------­--------------- --------------------#----------- <br /> L. <br /> ----------------------------- <br /> -------------FINAL .................. Date----- ----- <br /> INA N BY:4-"__ � - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California - <br /> 'ES 9 REVISED 6-59 LIM 5-6t ATLAS <br />