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FOR OFFICE USE: <br /> ----------------------------- -------------------- ------ <br /> -------------------------------------------------- _. 44PPLICATION>FOR SANITATIW PERMIT Permit No. .-,./ 2.7 <br /> ---------------­­--------------------- <br /> ._­�------------- (Complete" cate <br /> in <br />------------------------ --------------------—------- Thi Date lssuod'��.�/ <br /> I s- Permit Ex I Year From Date Issued 0 (7 - ado-37 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei. <br /> This application.is made in compliance with Counfyl Ordinance No. 549. n described. <br /> 2-It 1/ AJ r 4-ic(i.U4-/ <br /> JOB ADDRESS AND E OCAT119�...jO-U <br /> 11,�11, �': <br /> pii; <br /> Owner's Name---)te�_- v Z,_; 11 - - _ - -------- .... Phone--------------- ---------------------(I <br /> Address......................... dt� 'QI-- <br /> --------A.,C.5w------------ ..................................... <br /> -------- <br /> Contractor's Name..__. <br /> 1k- -- ----- ----- -- - -- ...... ------------------------ Phone--------------... ' . <br /> Installation <br /> hone--------------- <br /> Installation will serve: Residence Apa ment House',[] Commercial E] Trailer Court [:] Motel [3 Other <br /> Number of living units: Number of bedrooms Lot size ________________._---. ------------- <br /> D, <br /> Wafer Supply: Public system Community system 0❑ Flr�ivafi Depthi. <br /> TPIWater Table -------� ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy L Lo m Clay Loam ❑ <br /> Clay [I Adobe C] Hardp'ain 0 <br /> Previous Application Made: (If yes,date____________________) No,E] New Construction: Yes E] No L] FHA/VA: Yes ❑ !No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available <br /> Septic Tank: Distance from nearest well_________________Distance from foundation----------------.--.Material <br /> ElNo. of compartments--------------------------Size--------------- <br /> ------------- ---Liquiddepth------•--------- ------Capacity----------------------- <br /> Dis Id: Distance from nearest well-----%50!-----Distance from foundation---- j------_-----Distance to nearest lot line_________________ <br /> pwl� Number of lines_____.___X Length of each line----------711,-*•-------:�Wiclth of fren'ch----- .........k I <br /> Type of filter material...-.-_ filter material--------- length_____-14. ------------------1 t----- <br /> Seepage Pit: %1. <br /> Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line------ <br /> El Number of pits----------------- ---Lining material----------------------.S;ze: Diameter---------------- ---DepR'______ ___.__• <br /> j7... <br /> ---- th--- ------ ------ ---­-- - <br /> N, I ------. <br /> Cesspool: Distance from nearest rest well------------------Distance from foundation------------------- Lining material---------\----------------- 4 <br /> ❑ <br /> Size, Diameter------------------- Depth------------- -------------------- ----------"..gats. <br /> :--------------- -----------------Liquid Capacity------------ <br /> Privy- Distance_from-nearest-well---------------- <br /> --------------------- '65 <br /> i stance fr-om-near. tbuilding------------------------------------------ <br /> 0 Distance to nearest lot line-------------- -1 1 r <br /> ­ <br /> ------------------------•---------------------I----- ------------------------------------------------ -------------- <br /> Re r <br /> an r- ­ <br /> repa i ri ng.-(describe),.------------ <br /> ------------------------- -- <br /> ...................... ------------- <br /> ----------------------------------- - ------ <br /> ­----------------------_1---------------------- <br /> -------------- --------11-------- ---------- <br /> ------------- ------------------------------------------- ...........-------------- --- <br /> ---------------------------------::21----------------------------♦ -2--------------- <br /> - W 4 t. : .......------------------------------------------------------I---------------------------------------------------------------- -------- <br /> --------------------------------------------------------------- <br /> I hereby certify that <br /> % 1� i - ------------------------------ -----------------­- --------------------------------------------------- <br /> 1Fs I have prepared this application and that the'wo'A-will berdone"in accordance with San Joaquin Cou I rify <br /> ordinances. State laws, a d rules and _e6ulations of the-San Joa._quin-Loc'al"-Health District. <br /> ------------ <br /> ------------ --- - <br /> (Signed)------------_------ - <br /> -- -------- <br /> - --- --- ---- - --- --- - ------------------- -------------------------- ----------------------------------------- wrier and/or rifiaef <br /> gY� Cc <br /> JA . .... ...... <br /> - ------ ------- - -- --------- -- --------------------- -----------------------------------(rifle)------------_-----------------J.._-_.;-.... <br /> (Plot plan, showing size of lot, location of s sfem in elation to wells, buildings, etc., can be placed on reverse side). <br /> FOR btPARTMENT USE ONLY <br /> NV\ <br /> A?PEI'C'ATION ACCEPTED'15YI <br /> --------- -- ------------------------------------ DATE-- = <br /> REVIEWED <br /> ATE--- <br /> REVIEWEDBY------------- i ----------------------------------------11----------------------- -------------... DATE-----1--------­---- If <br /> -------------------------------- <br /> BUILDING PERMIT ISSUED.---------------------------------------- I-------------------'-----------i---­----------- PATE--------------------------- <br /> Alve'raft—on's and/or recommendations:______.__.._- <br /> -------------- <br /> -- -------; I I I <br /> ---------- ---------------------I------.............................---------------------------------------­ ------- <br /> ­­------------------- ---------------------­-----_--- ------------------------------------------ ------------------------------------------------------------------------------------------ <br /> ---------- <br /> ----------------------- ------------------------------------------------------------------r------_----------------------------­ --------------------------------------------------------------------------- -------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- <br /> -------------------­- .................._-------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ I-------- <br /> . <br /> FINAL INSPECTION BY: V�, <br /> ------------- <br /> ----------- Date._ -------- .....------- <br /> -----�SAN-J4D,-KQrU!ff'LOCAL 7HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 3ycamore Street 205 West <br /> Stockton,California % 91h Street <br /> Manteca,California <br /> �4-j 4, .. Tracy,California <br /> ES 9 REVISED 8-59 ZM 5-62 ATLAS <br />