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FOROFFIC SE: `] _ <br /> 1 <br /> ------­).d....... <br />--- - APPLICATION FOR SANITATION PERMIT ` Permit No. .. ............ !�... <br />--------------------------------------------------------- J <br />----------------- - -- -------------------- <br /> (Complete in Duplicate) ?�I <br /> ' _ ---- -------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued .....=_.._�: <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal{the work herein described. <br /> This application is made in compliance}} with County Ordinance No. 549. ot <br /> �fJ <br /> ADDRESS AND OCATION_.�S'?...✓�.--- �rrrer�__--_ T I <br /> J08 ADD <br /> Owner's Name------- Z�...._ <br /> ��Ph ne- ---••• .......... <br /> Addre 4 A4 -- -----------•---------------------------------------- �---------..-----•----- . ----•-- <br /> 270 <br /> Contra tor's Name----------- <br /> . Phone...........................I....... <br /> Installa-ion will serve: Residence g �Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> JJ <br /> Number of living uni .Z. Number of bedrooms,--. Number of baths .�r�r_. Lot size 1 .-/'f ......•........................... <br /> Water Supply: Public system❑ Community system [R"Private [_1 Private to Water Table 49 ft. <br /> Chara or of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe 8"OlHardp n ❑ <br />' Previou Application Made: (if yes,date.___--- .--_---.__-} No [� New Construction: Yes �No E] FHA/VA: Yes �o ❑ <br /> TYPE OPP _ <br /> F INSTALLATION AND SPECIFICATIONS: <br /> - No septic tank or cesspool permitted-if public sewer is available within 200 feet.) <br /> I ,fir s <br /> Septic ank: Distance from nearest w II__"'-�_____--DistanceNfrom foundation <br /> No. of compartments_3-------------------Size _,!(4-6-A�;1 _ Liquid depth---- --------------------Capacity./,* ---c- <br /> Disposal Field: Distance from nearest well---77r7n_____-Distance from foundation..-M., to nearest lot line. ...._._. <br /> Ie <br /> Number of lines-----.-�----- ----------•- -Length of each line_� �-•--- ��--------Width of trench._a2-- ---------......------- <br /> T,pe of filter material. DEpth.of_fil#er mater�a�..� otal_lenq#h ! ---------•-------�..-- •- <br /> E <br /> See a e Pit: Distance to nearest well----------------------Distance from foundation------ to net rest lot line-------- '' <br /> ] Number of pits-----------•----------Lining material-----------------------Size: Diameter-----------------------Depth I rrl1 <br /> Cesspool: Distance from nearest well----------------_Distance from foundation._.._______....___.Lining materia l_-------------...._____-----1.--_-_.. <br /> ❑ Size: Diameter--------------------------------------Depth------------------- •-- I---��t•_1"i------Liquid Capaci gals. <br /> Privy: Distance jrom nearest well-------------------------------------------------Distance from nearest building— --•---•.------------------•{••---... <br /> ❑ 3Dista ee'to �isarest lot line----------------------•-------------------------•--------------- ----------------••--- <br /> Remodeling and or repairing (describe):-------------•-- - I <br /> ------------------------------------------------------------------- -----------------------•-------------------•-••----------------------------- ------------------------- <br /> ------------------------------------•-••---•--------•----•----•----•-•. ..................................--------- <br /> GN <br /> --------------•--....-------- ----------------------------------------------------------- ,_--.-���,-------... t; <br /> I -ereby . . <br /> ce -fhat_I_hare+repare e this application and that thwork will be done in accordance with San Joaquin Clunty <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> _ -� r Contractor) <br /> I <br /> (Signed) ...... . 0....... lr 'If ••---- -N <br /> (rtlel �'---------- -- ----- ------ <br /> gY: --- ---------- - --------•------------------ <br /> (Plot plan, showing�slizehof lof,!jccofion of sysfe reiation�__ to wells, buildings, be-..placed on reh�erse side). <br /> I <br /> I FOR DEPARTMENT USE ONLY j - <br /> APPLICATION ACCEPTED BY-----C---•- 5-------------------------------------------------- DATE----�-1-.T. .Z. ------------ -------- <br /> - _�_ __.-___-� <br /> REVIEWEDBY------ ­ DATE .... -------------------------i=•-•------------------•--•------------- <br /> BUILDINGPERMIT ISSUED------------------------------------- ---- ---------------------------------------------------------- DATE ) -•------------------------------------ <br /> Alterations and/or recommendations----------------------------------------------------•---------•--•------------------------------.------------------- <br /> ------------- --------•---•---------------------------------------------------------------------------------------- --•--. ........................... <br /> �.. --...............-------------------------------------------------------------------------------------------------------------•--------•---------• -------------•------------------------- -------. <br /> ------------- <br /> --------- <br /> -------------------•---••----- <br /> --.....----•------------------------- -------------------- <br /> ----------------------------- -- ----••----------- ----------------------------- <br /> FIN L-gNSPECTIGN BY:- ------ -------------__ --.-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 west oak Sweet 1;24Lkyeamore',`SMnt 205 West 9th Street <br /> Stockton,California Lodl,California Manteca,California Tracy,California <br /> rG 9 REVISED 8-59 RIIA 5.61 ATLAS <br />