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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. .,,./ <br /> --------------------------------------- <br /> ........... . <br />--- ---------- --- ------------------------ ---------- t(Complete in Duplicate) ' S <br /> __________.___..__. This-Permit Expires 1 Year From Date Issued Date Issued __11.7....-3 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. e <br /> ..-•----..... <br /> JOB ADDRESS ANDOCATION �G" ZI--Owner's Name.... �'" -- ? - = �� -"Cy 'C� �- �- Phon4/51 <br /> . ,• <br /> Address_ .--/ - -------------••------------- -•-----•--•---- _ <br /> .. ---- n'- <br /> VIr <br /> Contractor's Name---- _ "`'` . _ter'. d r! •� ;r tf .•Phone `f <br /> I w � i <br /> Installation will serve: Residence Apartmen Ouse ❑� ommercial [�] Trailer O urt ❑ Motel ❑t'' Cher ❑ <br /> Number of living units: - ___ Number of bedrooms . ' <br /> ?rNumber of baths � �y�_. <br /> ------ Lot size __��_ .. --- --.�..-•----•.•----•---•------•- <br /> Water Supply: Public system []unity system ❑ Private ❑ Depth To Water Tabiejf- ft. i <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeldpnn (3 <br /> Previous Application Made: [if yes,date___ ___-------------) No t']--'Ne, C'onstruction: Yes ❑ No 6--F-H-A/�A: Yes ❑ No [ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ptic Tank: Distance from nearest well____-------------Distance from foundation----------------------Material________----_-.._______-___-_---._._________-__.. <br /> fNo. of compartments--------------------------Size...•-------------- . -:_Liquid depth--------------------------Capacity--•--------------•---- <br /> c <br /> j Number of lines.__---_---_ _ I-___._----,__.-.Len th of each line...:._____/_. • -Distance to nearest lot line----------------- \� <br /> isposal.rFi d: Distance from nearest well_____...____ V <br /> ' t ____Distance rein oun ation___� f Width of +ranch___ ` <br /> #" g `� <br /> Type of filter material....-c_ 'c_.____Depth of filter material-­e'-,4 ___-. -.Total length-------Z_t�....................�_-__ <br /> Seep a it: Distance to nearest well__, .i -Distance from f n'dation_s:!-._�.....- �� � . <br /> �_ Distance to nearest lot line__.�.__.._:f.`= <br />` Number of pits---•.•/�---F--------Lining material,: ,:....Size: Diameter-_,_�-___-_-...Depth__. %' sf- * :�. <br /> Cesspool: Distance from nearest well________________-Distance from foundation_.------------------Lining material--__"_-_---____________. ........ <br /> ❑ Size: Diameter--------------------------- -------Depth--!:�' :------------•-•----------------------------Liquid Capacity----------------.._.....----gals. <br /> Ii y❑ bis+aance_fro;nearest building--------------------------------r------". <br />� Priv .� ---Distance from nearest well-----------------------------------------_-- - -------•------------------------------------------------------- -------- ,. <br /> Distance-teneares+ lot line_____."________________________________-_------ <br /> . ........ <br /> `, �, �^L-%..-� ,,,�` �.._ __�_`_� __: f>= vhf _�._ __�'__ �__ _ _ - .`• ___ _____ ----- _.-__.._._._ <br /> --------------- <br /> ----------------- <br /> hereby certify #hat I have prepay 'd this application and that the work ill be done in accordance with Sen Joaquin County <br /> ordinances, State laws and:Foles and e6ulat his of the Se 'Joaquin oval 11talth District. <br /> Signed} '`" .- � ' -- ': �< - ` u. ; ._ O�+�nera d Contractor] <br /> �ri T1+101)--- <br /> ------ <br /> BY:-------. ..... ` ] <br /> (Plot plan, show size a t, o ac iia.- yst' eminreion to wells, buildings,-etc.,.can be"plare on rever -sid <br /> 5 <br /> Fr/OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- L i. f -------------•--•--•---•---------------- DATE---------- -s ---- .._...... <br /> aREVIEWED BY-----------------•-----------•----- -------------------------- -----------------------------....------------ DATE-------------------------.------------------------------..-. <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------•-------------------------------------••----- <br /> Aiterafins an or recommendations:-------------------------------------------------------------------------------------------------••-•--------•------- --------•------------------•----------- <br /> :.i, = --••----'Z"' =----------------------- <br /> ---------- ------r_s ----------- ---"—-------- `� ' �'-• ...................... _......�J, ........ <br /> �''J <br /> -•-•-•-------------------------------------------------- _--- <br /> ---------------------------­- f �.ale .:.__...---------- —:---------------------------- <br /> -------------------------------- - - ------- -----------------------------------------------------I-------------------------------------•---------------------------------------------- ---------------------------------- <br /> FINAL INSPECTION BY------------- -., -- -----.. <br /> ------- Date-------------S'_ _.._ - --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Svreet 124 Sycamore street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REWSED 8.59 2M 5-62 ATLAS <br />