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FOR OFFICE USE: <br /> / <br /> ' , M I <br /> APPLICATION FOR SANITATION PERMIT Permit No. .... .` __......•... <br /> ---------------------------------------------- (Complete in Duplicate) 41./ <br /> - t1. Date Issued -�_._ r' <br /> This Permit Expires 1 Year From Date Issued ,+� <br /> Application is hereby made to the Sari Joaquin Local Heal+h District for a permit to construct"and install the work herein described. <br /> This application is made incompliance with County Ordinance No. 549. r <br /> JOBADDRESSIJAND LOCATION- _ ,!.F--------------- � ---•----- 4=---------------------------------------------------------------------••--••-------- I <br /> Owners ------1`71LtiPsP/3......................................------------ Phone.,/2'9' 473.2.._: ' <br /> Address__.. •23=3s5. tQ�?! f..-�lJi ------- <br /> Contractor's Name.... -_-JA-1C -----------------------------•-------------------- •---- ff!'6��Q7 <br /> . Phone-----•--• -• •-•- -- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ <br /> Number of living units: __/__! Number of bedrooms _/____!_ Number of baths 1-_-_ Lot size ...,5__O_•-X...7 ............................ <br /> Water Supply: Public system ,Community`system ElPrivate L] Depth to Water Table _ . ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ .Clay Loam ❑ Clay ❑ Adobe d Hardpan ❑ <br /> I <br /> Previous Application Made: (if yes,date---------------------1 No Q"' New Construction: Yes 2""No ❑ FHANA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / <br /> Septic ank: Distance from nearest well_A/A9N ___Distance from foundation___%fJ_.`_...__Material-___ p.P..K............... <br /> -3 X.S. .Liquid depth--•---�-------------- Capacity.-- <br /> No. of compartments.......... � � t -- � L�Ql�---• ••--- <br /> Disposal Field: <br /> �. Distance <br /> nearest Ieli_1!d_�l- Distance from foundation--- <br /> � iDistance to <br /> est Iline � <br /> Number lines --Lenth of each C -_......_.Widthoftrech � �*----- ---- <br /> Type <br /> of filter material.-.-RAC&-------Depth,of•filter material......1AP..........Total length----------4-/ '--------------------- <br /> Seeps Pit: Distance to nearest well--- 4/V .---Distance from foundation----3.(-.0:...___.Distance to nearest lot line---. __°....... I' <br /> -Number of pits--___.]____________Lining material---- --- -- ------Size: Diameter----_ 333_ '.......Depth------9-LS=.'.__.....__._.... <br /> Cesspool: r Distance from nearest well.--------------Distance from foundation--------------------Lining material------------------------------- <br /> Size: <br /> --_---__------_-_.-___--_-._Size: Diameter-------------------I-----------------De th------------------------•------------------- ------Liquid Capacity------------_------------gals. , <br /> `•�Diste cn a from nearest building <br /> .a ,e <br /> Privy: - Distance from .nearest well--------•---------------•- ----------------- ------------•-••--------------._....------ <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------ -------------------------------------------------------------------.._ <br /> Remodeling and/or repairing (describei:---------0% -.---r =-7C/12...-72o_.--- ` 1N,f'x-------------------------------- <br /> ---- •- <br /> ---•---•-•--••--------- ----•----------------­-------------------------------------------------••-•----•--------- -•-•----•-----------------••-----•----------------•----------------•- •-•------------••----------- <br /> ------------------------ ----------------------------------....----'------------------------- •---•--------------------•--------------------- ----------•--------••---------------_._._...._.. <br /> 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 /> (Signed).. r//�� 1•�iY-- �P/Y+.r------.P/Y�"n {Owner and/or Contractor) <br /> By:... zr ; --... ----------- -- - ----{�i......--- (rifle) �� ' <br /> (Plot plan, showing size of lot, Iota ion of systeril in relation to walls, buildings, etc., cari be placed on reverse side). <br /> t FOR DEPARTMENT USE ONLY , <br /> APPLICATION ACCEPTED BY-- -- -------- -- _ - ---------------- --------------------------------------- DATE-- - /Q iL? - -- ----•--•-- <br /> REVIEWEDBY........ -------------------- DATE---------------------------------------------------•------ <br /> BUILDINGPERMIT ISSUED--------------- =-------------------------- ---------------'----------•-• 1. DATE---------------------------------- --------- <br /> Alterations and/or recommendations:___- �,,p .-- -� --- =J C ��`�� -•---• <br /> �` �- -- t ------------- <br /> i <br /> 1 y <br /> --....---•---y.... .. ................... <br /> C <br /> FINAL''INSPECTION B - - - —----------------- �Date.. f_e;..-� � - .� <br /> = SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> r Stockton,California Lodi,California Mant►ca,California Tracy,California <br /> Es 9 REVISED 8-59 RM 5-61 ATLAS - <br />