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&TtCE USE:: <br /> '------------------ ° x / ` ~ <br /> APPLICATION_ FOS `SANITATION PERMIT -"` { <br /> Permit No. <br /> ^ _r Duplicate) <br /> l__ C ---------.— [Complete in Dup' ) 1 ti <br /> a .. '- �` Date Issued ---- :._1 - <br /> _ _ ____ _________________ .-._ This Permit Expires 1 Year From Date Issued <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. t <br /> � - <br /> JOB ADDRESS AND LOCATION ------------- ----------- <br /> Owner's Name--------- /` hone <br /> r <br /> Address-----•----------------- '- as % f <br /> Contractor's Name-------- :�� <br /> � a ---------------------------------------------- Phone......---------------------------- <br /> Installation will serve: Residence Apartment House [],Commercial ❑ Trailer Court E] Motel [I Other ❑ <br /> Number of living units: __. -- Nu er of bed-r0.ooms:__z=N�mber of baths ___1___ Lot size -__� ___ _- ':° ----------------- •` <br /> Water Supply: Public system Community system❑ Private f❑ Depth to Water Table _______ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe dean ❑ <br /> Previous Application Made: (If yes date__.._...____- _ .:.) No A ew Construction: Yes P_ ❑ FHA/VA; 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 Ta Distance from nearest welkr--------Distance frorn found ion---Z._----------MaterIaL-.e-�'__ <br /> No. of compartments_--.--.-_-.� .__Size-------� Xv._..Llquid de h_____. 1 .-__CapacitY______ ------.--_-___ yE <br /> Disposal e d: Distance from nearest,welL_ Distance from foundation _ _`_ A Distance to nearest lot line_ -.-.-.. <br /> R { T - <br /> Number of lines_`________ Length of each line________®____-.j_-_.,Width of trench-�. _-__�1.___---_-._-___-- <br /> I----- - -- <br /> 7 e of-filter. material___.1� �_4c_�e th of filter material_---- _1 p J -T,�ofal length__________ __ Q <br /> Seepage If: <br /> Distance to nearest welL_ Distance from f undation____ �_f.Distant a to near o line-._-.._ <br /> p / f <br /> Number of sts------------ ------Linin material_�r^O.C.1 --__---.-Size: <br /> Diameter-- ___.._-_ Dep ----------------- _ 1V , <br /> ❑ .. P g <br /> �. <br /> Cesspool: Distance from nearest well�-----------Distance from foundation.__-----_:______'.Lmmg material___________________________________. <br /> ❑ Size: Diameter--------------------- ._- - 'Liquid Capacity <br /> F Depth - : 9 ---------------------------gals. = <br /> Privy: Distance from nearest well__ s_'___----_--______--________--__-------Distance from nearest blpilding---------------------------------_--------- I <br /> ❑ Distance to nearest lot line - ----------- ;--------------------------------------------- b <br /> Remodelin and/or re airin describe __________________ ------- - - <br /> -----------------------•--------------11 -------------•-------------------------=--------------------- -------------- -. - ------ <br /> -------------------------------- <br /> ------ ``= <br /> = ------------•----------------------------------•-••-------------..._..--------------- <br /> ---=-----------•-•-------------------------------- <br /> II hereby certify that I have pre. red this application and that the work will be done in accordance with San Joaquin County <br />' ordinances, State la s, d rules d re ulations of +he San Joaquin Local Health District. <br /> ! ---- ------------------------------------------- <br /> (Signed ---[Owner and/or Contractorl <br /> } ----------- ' <br /> B . - = ---- -- -- ---------------------------(Title)- <br /> --- --- t <br /> (Plot plan, showing size of to ation of system in relation fo uildings, a+c,, can_be.placed on reverse side). ti <br /> ,- <br /> j FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------- -------_ <br /> DATE 'r-1 17-� ---------------------- <br /> REVIEWEDBY------ -------------------------- ----------------------------------------------------------- -------------------- .... DATE----------------------------------------------------------- <br /> ` BUILDING PERMIT ISSUED------------------------------------------------------------------------- -----------•------- ------- DATE--------•--•--•--------------------------------------------- <br /> Alter ns and/or re ommendations-------------.____:__.-_-____- _- <br /> i � R <br /> JOI <br /> "'"Z_, - -!-- � ----- ---------------------------------- ---- ------------------------------•--- <br /> (. } Oyu (�¢ /��Jj G/4/j <br /> ------" w/L-=--"". 4-6`�-----• --•- "'-`--"-_-"-- - - �­*. J1-< ---------- - i <br /> 1 tirI ► -------- `- - - ---------------------------- <br /> ------------------------- <br /> (o <br /> ----- ------------ <br /> rca� <br /> L ` _ <br /> ---6'f�-- -:.. r --- -- - - - r <br /> FINAL INSPECTION BY:----------- -----------------------`-=----------------{ Date-----fes -------0 ---------------------_-- ----- <br /> -------------- <br /> /2 7 SAN �JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 3M 3-'63 F-P-CCJ. - <br />