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FOR OFFI USE/ <br />----------------- ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --•-----•.--- .. <br />-------------------------------------------------------- (Complete in Duplicate) <br /> ------- This Permit Expires 1 Year From Date Issued Date Issued .................�_.0�e <br /> Application is hereby made to the San'Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br /> This application is made in compliance•with County Ordinance No. 549. <br /> f " <br /> JOB ADDRESS AND LOCATION...... /-------- ----------------� .......... <br /> -•-•--•--••------------- <br /> - <br /> Owner's Name----------._-• .a,Cl.`-------- ���-�./!��--------------------------------------------------------- <br /> Address ` -------------•-----------•--------------------------------••------------- ••- <br /> -----------•--•---;;.....-•- <br /> 1 / <br /> Contractor's Name_._ ...- ��-^ '_ _!_L. �-• .-----..1 -o---------------------------------------- Phone.-_-__--- A!.J <br /> knstallation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑\ <br /> Number of living units: . Number of bedrooms __ _ Number of baths ___L Lot size -... _____jg <br /> ........_ <br /> Water Supply': - Public system` Community system ❑ Private ❑ Depth to Water Table 6-'eft. <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan <br /> P ❑ ❑ Y ❑ y ❑ Y ❑ : ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ NoV FHA/VA-. Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> e f f-ra : 1 Distance from nearest well.................Distance from foundation___-_.---•-_______-Material---------------------------------------:...._.:... <br /> No. of com artments--------------------------Size__.•___...-.----_ Liquid-deth_------•-----------------Capacity ....... <br /> lspo �., 'eld: Distance ftom nearest well_________________Distance from foundation....................Distance to nearest lot line.____:'.......... <br /> i Number of lines_._.i------------------------_---Length of each line----•-------------------------Width of trench--------------------_----------.--- <br /> Type of filter materia------------------------- of filter material____.____________.__-__Total length........!..........._._......-___-_ <br /> t .g ' 1 <br /> See a e Pit: Distance to nearest wellA0t.A,.___Distance from oundation... ..--":Distan��to nearest,lo line____00 <br /> _________ 3 <br /> Number of pits.....................Lining material-_ loaTA__._Size: Diameter__ . ....... <br /> f�+• --• <br /> Cesspool: Distance from nearest well----- from foundation____________.._-___.Lining material----.__'___._....................... �R <br /> ❑ Size: Diameter------------•v--------------------__D'epth-----------------------------------------------------Liquid Capacity------•----•----........--•-gals. A <br /> Privy: Distance from nearest well_______________________________________________Distance from nearest building.......................................... ;� <br /> ClDistance to. nearest lot `----•----------------------------------;*--------------------...............•--..... --••-------...----...._....._-.-------•-------- <br /> Remodeling and/or repairing (descr-----------------------------------------------------------I..ibe) ln--------------------------- <br /> :.------- -- = ------ <br /> i e Is <br /> .... <br /> ____________________________________._______-••_------------___-_;_--.-_-_-... _ ... -f•-. 7yro- ___M-_ _____ ____/--- ¢G _._____._....__..__..______ <br /> i : <br /> ---•--•-------•----•--•------•-- ----- -•----•-•-- •-••------- ---- V <br /> I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' <br /> ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)- �"� -N—LA40�t....s;l – ------ LContractor) <br /> - <br /> - � __ ... Title <br /> (Plot plan, showing size of lot, location of system in relation to w ,buildings, etc an be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- -- - ------ ----- ------------------------------------------------------- DATE-I--off -- ---- ----- ------ <br /> REVIEWEDBY--_---------------------------------- ----•-------•----------------•------------------------------------------------------ DATE_.------------------------------------------ ------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:_.--• r------------- ; <br /> �..� J- --------------------------------------- <br /> i <br /> FINAL INSPECTION BY: Ji Date. �� <br /> CACHEATH.DISTRICTOQUINiLO <br /> 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th street <br /> Stockton,California t Lodi,California Manteca,California Tracy,California <br /> a <br /> ES 9 REVISED 8-59 8M 5-51 ATLAS <br />