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FOR OFFICE USE: <br /> --- ------------------- --------------------------- <br /> ........... -------------------- I-------------- APPLICATION FOR SANITATION PERMIT Permit No. ............. <br /> ----------------------------------------- (Complete in Duplicate) <br /> -- - -------- -- <br /> -- -- - ....... <br /> -------- <br /> ----I------ This Permit Expires I Year From Date Issued Date Issued ............... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the workf*rein densiribed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND ;--•-,---- 2A op SJE_=/0 /7_)EEI 'r— SIDE- <br /> -------------------- <br /> Owner's -------------------------------------------------------------------------------------------- Phone.... <br /> OCATION /! jr ------- _0 <br /> --- --------- - <br /> Name. <br /> ------ ...... <br /> ---------S-P -------------------------­------------- <br /> ------------------•---------------------- <br /> Contractor's Name__A1t9.NTj.E.-cjq"!, � —------------------------------------ ' j <br /> Phone.........------------------------- <br /> Installation will serve: Residence gr Apartment House F] Commercial [-] Trailer Court [] Motel [3 Other ❑ <br /> Number of living units-. Number of bedrooms --- Number of l 'baths Lot"Isize ...... . ..... ...................... <br /> Water Supply: Public system E]-4,-Ciornmunify syGravel <br /> 0 Private W-D'epth to Watei la' 61-e <br /> Character of soil to a depth of 3 feet: Sanravel [:] Sandy Loam Clay Loam E] Clay 0 Adobe[3 Hardpan <br /> a�'Pc_ <br /> Previous Application Made: jif yes,date............. No r— New Construction: Yes,?3 No F] FHA/VA; Yes Ej No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r —4 <br /> Se t' Talk: Distance from nearest well ----Distance" fro f clation-10-------Material <br /> P q na <br /> No. of compartments---------el---------------Size._3_Vr__.T_05-_.___Li quid depth------ ..______._____:_._Ca aci Disposal Field. Distance from nearest well_________ _-Distance from founclLation-10-----------Distance to nearest lot <br /> Number of lines-__!___... ._:! . -------------------Length of each line 50- ---- <br /> ---- ---Vidth of french------- -- <br /> - ---- ......... <br /> .. 1 4' <br /> Type of filter materia- 0__C_K\----Depth of filter material..__._ ___.___Total length.------------5--C-------------------- <br /> Seepage Pit: Distance to nearest �well----------Dis-f'tance-fro'm---f'oundation....................Distance to nearest lot line.-__-__________-_ <br /> ❑ <br /> ine----------------- <br /> 17 Number of pits....,----:---_---::__Lining-material--.-_-----------------Size: Diameter------------------------Depth----------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..______-----__-___-.-________-...... <br /> 1-1 Size: DiarrIeNer----------------------------------- __Depfh.---------------------------------------------------Li uid Capacity---------_----------------gas. • <br /> Privy: Distance from nearest well--.___------ ----------——--.---._Distance from nearest building________________________-- --- <br /> --------------- ----- ..... <br /> ❑ Distance to nearest [of line------ <br /> -----------------------------------------------------------------------------------------------------------------*--------------------- <br /> Remodeling and/or repairing (describe):----------------- -----------------r-------------------------------- <br /> ':------------------------------------------*------------------------------------------- <br /> --------------------- ------------------------------I-------- ­----------------------------------------------- -------------------------------I--------------------------------------------------------- <br /> -------------------------------------- ­----------------------:----------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ ------------------------------------------------I-------7........................----------------------------------------------------- ---------- ---------------------------------- <br /> I hereby certify that I have prephred this application and that the work will be done in accordance with San Joaquin C fy <br /> ordinances, State IMs, ;��nddules and "' I ti the San Joaquin Local Health District. <br /> �r, ions o <br /> 41/1 <br /> (Signed)------------ .... <br /> --- ---------------­- --- ----- -- -------------------- ---------- --------- <br /> ------------------------- -----(Owner and/or Contractor) <br /> By:----- ------_-------------................ ------------------------------------------ --------------------------(ride)---------------------- ----------------- - - -- -------------- <br /> oj� <br /> (Plot plan, showing size of lot, loc on of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> Ty <br /> a.jc1o,, <br /> FOR DEPARTMENT USE ONLY <br /> -T-_—7D C). . . <br /> APPLICATION ACCEPTED BY----.--- tf-)== '� --------------------- <br /> --------------- D ----------------- <br /> REVIEWED-BY------------------------------------ <br /> -------------------­--------------- --------------------­- <br /> ------------------------------------------- ---DATE- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE----------------------------------------------- <br /> Alterations and/or recommendations;---------------------- ..... ------------------------------------------------------------------- ----------------------------------------- <br /> --------------------------------- --------------­---------------: �_` <br /> --------------- .. .. ..........I........... ----------------- <br /> 'if-----**------- . - -------------------------------- .......... ---------------------- --- ------- <br /> ---------------------------------------------------------------- A <br /> 1, �__---------------------------------------------------------------------- -----------------------------------------�-�t--­---------------------------- <br /> �,rK - <br /> ................................------------ <br /> -7- <br /> ------------------- ------ -rll--- ------ ----------------------------------------------------------­­-------------------------- ------ <br /> ---------------------­ ----­---------- -- - ------------------- - ----- .:-- -------- ----------------------------------12-11-I--------------------------------------------------------------- Z, <br /> JFINAL --- ---- ----------- - Date------ <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 Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5-59 2M 5-6t ATLAS <br />