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FOR OFFICE US ^' <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._ ��.5 .-. <br /> Com_ <br /> -•------------------------------------- -- , (Complete in Duplicate) <br /> -------------- ----------- ---------------- -- Date Issued ......4/ <br /> A lication Is hereby made to fibs San Joaquini eLoclal Health District <br /> ,o,orn Date Issued E� <br /> ----� From <br /> PP Yfor a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. li <br />�. JOB ADDRESS AND LOCATION....Y -: -r. <br /> Owner's Name-- - ---------------•----•---------------------------------------•--I--------•----------------------------------- Phone.................................... <br /> Address-----" ``-<W Z. .{ <br /> "' ---------------------------------------•---------•------•------------------------------------------------------------------------------------------ <br /> Contractor's Name......-- TSS--f-------------------------------------•--------------------------------------- Phone................................... <br /> a <br /> Installation will serve: Residence E!r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> t <br /> Number of living units: ----I Number of bedrooms --=� Number of baths ---/--- Lot size -----,'7_-r-- ................................... <br /> Water Supply: Public system ❑ Community system ❑ Private [9---D–epth To Water Table --------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®Hardpan ❑ <br /> Previous Application Made: (I#yes,date--------------- ) No Er New Construction: Yes D-No ❑ FHA/VA: Yes ❑ Noe- <br /> TYPE <br /> o -TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r <br /> iSeptic fAk: istance from nearest well-----------------Distance from foundation--------------------Material---.-------------.---.-_____-. <br /> o. of compartments--------------------- ----Size__--------------------------Liquid depth--------------------------Capacity...----------.-..------ <br /> Disposa jFieId: stance from nearest well-----------------Distance from foundation----------------.--.Distance to nearest lot line----------------- <br /> Number of lines;----------------------------------Length of each line_---_-_---------_-_-._ -----.Width of french----------------------------------- <br /> ((( Type of filter material-------------------------Depth of filter material-----------------------Total length,,---------------------------------------- <br /> � �} <br /> Seepage Pit: Distance to nearest weH--./[ ----------- from foundation__JA...........Distance to nearest lot line_.-..--_.._--_ <br /> ®� Number of pits--I---I-------------Lining material----?.GC,f°...Size: Diameter--_------- .- ----,Depth--_2 1---------___--------- (� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ <br /> qCapacity.. a Size: Diameter- ------------------------------------- Depth------------ -- -----------------------------------Li Liquid ------------------........gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------.-..-_--___-------------. <br /> Distance to nearest Sot line---------------------------------------------------------------------------------- <br /> RemodRemodeling <br /> eling and/or repairing (describe):------- ---------------------------------------------------- --•------------------------- ------------- ..................................... <br /> -----•---------••---------------------------- -------------------------------------:­------------------------------•--------•--------------•---•-----------I--•------------------- <br /> ------------ ----------------••------•---------I—--------..--------------------------------•-------•.......•------------------------------------------------------------------------------ --------------------------- �I <br /> hereby that I hpsoJ that m lecaccordance_with San Joequin County <br /> ordinancestate laws, andrules and regulationf the San Joaquin HealthDitr f <br /> (Signed)---------------------------------------------------------------------------------------------------------------------------------------------------------------- (Owner and/or Contractor) <br /> SY ------------ ------•----------------------------------------------------------(Title)---------------------------------------- -- - -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> r - - <br /> t <br /> } FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -- -------- = ------------------------------•--- DATE----- <br /> REVIEWFDBY------------------------------------------ ------------------------------------------------------------------------------ DATE------------ <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------- •-•------------------- DATE.----- �. <br /> Alterations and/or recIomm d'afttona:-.--_-. ------ -----------------••---------------- <br /> --- <br /> ----- -- - ---- <br /> 1 L,�.�,2....`r_.1�. a --- --- -- ------ `~ c `1 t` r <br /> ... --�'--------------------•--• --- <br /> --------------------------------------------------------------------------- - ---- ----------------------------------------------------------- -------------------------------------- ------•-----------.--------.--. <br /> FINAL INSPECTION BY:.. = ),SAN <br /> ------- --- ----------- Date------3----� Y�7_ <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Streef f 300 West Oak Strut 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> £5 9 REVISED B-59 2M 5-62 ATLAS <br />