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FOR OFFICE USE: <br />--------------------------------------------------- <br /> fs, <br /> APPLICATION FOR SANITATION PERMIT Permit No. .I�.re! <br />--------------------- <br /> ------------------------------------ <br /> 1. <br /> ---------------------I----------------------­---- (Complete in Duplicate) J <br /> ------------------------------------------------------ This Permit Expires 1 Year From Date Issued <br /> Data Issued <br /> Issued <br /> install ru <br /> Application is hereby made to the San Joaquin L'o''ca-1 Health District for a-lberimir to(tons ru install the work herein described. <br /> This application is made in compliance with County Ordinance N6.:549.-'- (7 0-07 <br /> ION ------ <br /> 'JOB A RESS AND LOCA .. .. .. . ............... <br /> -------------------- ................. <br /> Owner's Name.---- ------- one.................. <br /> Address....... .............. .. ...........�2------------- --- <br /> --- ................ . .. ............................ .................................................................... ------- <br /> Name._ --------- .... Phone---............................... <br /> Contractor's ------------------ <br /> Installation will serve: Residence ❑ Apart ent House [3 Commercial TrailerCourt [:1 Motel Q Other 0 <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -I_--Lot size .............. . .......... ...............­--------- <br /> �Weter Supp Public system E] Community system El Private Oq Depth to Wate<Cab�lle 6-0. <br /> Charact re of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Coarn�] lay [3 Adobe 0 ,Hardpan,W' <br /> Previous Application Made: (if yes,date----------------_-_) Na ❑ New Construction:-yes E],, No [] FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: z4.Z <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r. .,4, <br /> SPpti&-T-6,*.,`—Distahce-from nea"�rst �from­'foundaiti&--------T----------M� -------.................­­­ <br /> zl <br /> Size......Z...... <br /> El No. of compartments................... Si ... ...... ... Liquid depth_..------ .......capacity....................... <br /> Dimpsal Field: Distance from nearest well-__5Distance from foundation----_--_/ ._...Distance to nearest lot line.... <br /> Number of lines------------- --------- Length of each line-------b_0--------------Width of trench.....0,2 / <br /> .................. <br /> Type of filter -...--'Depth- of filter Total length------ ------- ------------ <br /> 'from d ti 15 <br /> -."Seepage Pit: Distance to nearest well- -----00--- Distance f9un a ion.....h?------ Distance to nearest lot line---------------- <br /> i-i Number of pits--------- ------------Lining material_.e.44d-A-__..Size: Diameter--------- --_Depth_,X-*--- <br /> 1 4 9 ­_­---------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.................._.................. <br /> .I Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity.-..........................gals.- a <br /> Priv <br /> apacity. ..........................gals.- <br /> Privy:, Distance from nearest well--------------------------___ __.__----Distance from nearest building--------------------------------------- <br /> Distance to nearest lot line------------------- ----------------------------------------------------------------------------------------------------------- <br /> Remo ------ - ------------------------- <br /> deling and/or repairing (describe):---- - -- ---------------- i <br /> -----------------­-----------....................................................... <br /> :....---•-----•-------------------------------------------- - -------------------------------------------------------------------------------------------- ------------ <br /> -------------- ----------------------------------------------I------------- ------------------- ..... ---------------------------------d..-.........------------ ----------- <br /> --------------------- -------------------------------------------------------------------------:f��------------------------------------I--------------­--------1-----------------------------------a----------------------- <br /> .,,I certify that I have prepared this application and-+hat the work wilF be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ontractor <br /> (Signed). _12_._.... ....� �=`�` rwrrd/oC )4. . m --------- <br /> B .. ------------------------------------ <br /> - <br /> (rfle)..P.... <br /> (Plot plan, showing size of lot, location of system in rely n to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> --------------- <br /> --•--------------y--•-- DATE....-L-. ---------------------------- <br /> ---WX04 <br /> REVIEWEDBY---------------------------------------------------------------------------------------------------------------- ......... DATE--------------------_--------_------------------------- 31 <br /> BUILDING PERMIT ISSUED-----------------------------------------------------------•-------------•-------•---.._...-._-:..:. DATE------------------------------------­­­------------------- !411 <br /> Alterations and/or recommendations:------------------------- ---------_ " - - ......................I—----------------------------------------- <br /> ---------------------------------I-------------------------------------------------------------------- --------­------------------------------------------'--------------------------------------•----------- <br /> ---------------------­-­ ­-­------ -------------- ------ ------------------- --------------------------------------------------------------------------- ------------------------------ <br /> -•--•------------------------------------ <br /> ------------------------------------------------------------------------------------------------ -------------------7'' ------------------------ ------------------ - -----------.. -------------------------------------------------------------------------------- <br /> ----------- <br /> - -------- - - - .......... <br /> ! - % <br /> ) I <br /> -:7- <br /> FINAL INSPECTION BY:-- ----------------------- Date-------- -_ .. <br /> ?! ---- .... --------------­- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH-DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California LOCH,California Manteca,California Tracy,California <br /> EA 9 REVISED 8-59 2M 5-6t ATLAS <br />