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FOR OFFICE USE: <br /> c' Permit No. .. <br /> APPLICATION FOR SANITATION PERMIT <br /> . .....----- ----•- -- ---------- ------ (Complete in Duplicate) <br /> ...... This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct an Insta I the woft herein described. <br /> This application is made in compliance with County Ordinance No.-549. /j Wi•, 3-owra OF A/NOFi✓ JP <br /> RO ..f _• _ ._ .. E _ _ ..............JOB ADDRESS AND LOCATION.&Y. Q7 Q d <br /> Owner's Name......0-9...----- ....... ......... . .....•-•--------------------- -------------- Phone---------_-----_-----------•-•- <br /> Address-------,�Q,t!_ ,eC07 --------------------------------------- ----------------- ---------------....-...................................................................... <br /> Contractor's Name---..t7)•t�l_�.�.p� ,[f�H---X.5 ....bvo--'.......................... . �' _ one. �. __... <br /> Ph ,fW �� <br /> Installation"Will serve: Residence 0"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: . .. Number of bedrooms .�.- Number of baths, - Lot size ...sS7�?.-- --����' � � <br /> .. <br /> Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table ........ ft. , <br /> Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Seri'dyloam❑ Clay Loam (-'Clay❑ Adobe❑ Hardpan Fj <br /> Previous Application Made: (If yes,date........ ..........) No lfflllNew Construction.,Yes ❑ No ff-_FHA/VA: Yes ❑ No❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool per fitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from neaIrst weil.................Distance from foundation....................Material----------.-------------------------------------- <br /> ❑ 64A3'11N��No. of compartments..........--------- •...Size........---•---••-------•------Liquid depth._..- R......_Capacity.... ... <br /> Disposal Field: Distance fro�rn,nearest wefl�' R _�_..Distence from foundation_..'_±_._._Distance to nearest !ot <br /> 'o. <br /> [� L%*5711NOP Number of lines::._ ../------...__-_-_---.._Length of each line_..;.I�_K .........Width of trench..____._ .-.�............... <br /> ivv Type of filter material_RO.��t_._...._.Depth of filter materlal.1k-------------------Total length; ...___���p...............-` <br /> Seepage Pit: \ Distance to nearest well..-------Distance from foundation_...t4 #---Die anye to nearest lot line� � <br /> ER MS"-"'Number of pits;- f.-•.--- .Lining material....Tl0..�1.<__._.Size: Diameter.....4Z&......... <br /> Depth......y`�.> ................ <br /> IjriO �, <br /> Cesspool: Distance from nearest waif.....:.........tDistance from founilafiion..... ---....____`.Lining materiel_..........._._.___.___._______....__ 5 <br /> ❑ Size: Diameter------------ - --------------."....!Depth--------'_----.-___-------- ....................?Liquid Capacity------------.-__---...---...gals. <br /> N. 4 <br /> Privy: Distance from nearest well......................:...........•-•-...........Distance from nearest building..................................... .. <br /> ❑ Distance to near st lot line----------------------I...r.. ......................................................................------..._.......-•------•----- <br /> t , <br /> Remodeling and/or repairing (describej:__.•-- -----TL't it's!,.ST/_�YC� ---.. ,f'`,s..roelYl.............................................. <br /> ....................................................... <br /> -•................•----------------.....--------•------...••-•--•---• ........... <br /> •• 1 , ' ti <br /> -----•------•-----..------------------------ <br /> ------•------------------------------------•--.--.-------------.-..--.-n....---•--...................-•--••-•----..-----------.............................................................................................. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> 5i ned ��` .............. ... ._....... (Owper end/or Contractor) <br /> * s�, 10 <br /> ..-----..(Title). -1 ..... ............ <br /> BY:.......... -- -------•--------------------- <br /> (Plot plan, showing s'tie of lot, loeat' of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY • ; f <br /> APPLICATION ACCEPTED BY.___._.. ..�. .. .... ^� --------••••• -•---------- <br /> DATE. . . <br /> ....... ,,._/....._E. <br /> REVIEWED BY..... ` ...... .. DATE-------• ----•` <br /> pE ------------- <br /> BUILDING PERMIT ISSUED.....................................�..._._.._..0........ o 'T l� /f <br /> Alterations and/or recommendations:__..... Y---------- ---- --- ------------- 2� - - ... ....... ....-• .....- <br /> ..#........................•----------------._...........------- <br /> rIt ............................................. <br /> t <br /> ......................................................................'................... ................ <br /> ....................................................................................•----.............I.................... <br /> • cam-'�- . �®.c j ; c� / b.. . <br /> FINAL INSPECTION BY:��/- Date.. ........ .........,/,,...... -... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Stroot 203 West 9th Street <br /> Stockton,California Lodi,California Manteca,California ?racy,California <br /> ES 9 REVISED e•59 2M 5-62 ATLAS <br />