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FOR OFFICE USE: a <br /> ------------------------------------ <br />--------------------_.-_.--_.._.._-.-_--_.-._-.-___-. APPLICATION FOR SANITATION PERMIT Permit No. ... 5......__ <br /> -------------------------­-------------------------- (Complete in Duplicate) �/ � <br /> Date Issued <br />-=---------------- __ d._--_---.-.- 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. <br /> JOB ADDRESS AND LOCATION------ �-��� f-- •------------- --------- ----1 J . tcuE----------.....--------- <br /> Owner's Name----- �._a ........`-- . --- ---------- --------------------------------------- ----------------------- <br /> Phone. ----------------_---------- <br /> - <br /> Address <br /> 1( Lf-- ® 0----- '; ___4 -.'"`"---- ------------------------------------------•-.......•.................... <br /> Contractor's Namb:.� !-..-_Cx,C[R � �...... G`C+-------------------------------------------- Phone..... S.,: <br /> Installation will serve: Residence ❑ Apartment House ❑�Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: .i�� <br /> tuber of bedrooms -------- Number of baths J--- Lot size ../- -- __ ®. ...................... <br /> Water Supply: Public system mmunity system ❑ Private ❑ Depth To Water Table ��ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,Hardpan ❑ <br /> Previous Application Made: (If yes,date-5/.fFlS6.) No ❑ New Construction: Yes ❑ No FHA/VA. Yes ❑ No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS*7653 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> STa : Distance from nearest well_________________Distance from foundation._._.__.____-______-Material------------------------- <br /> ._.. `,. ... <br /> r�kNo. of compartments--.-----•-- -----•-•-___--Size---•----------------------------Liquid-depth--------------------------Capacity,p - <br /> Di al Field- Distance from nearest well- -0--p---Distance from foundation..-J r•--Distance to nearest lot line....... r <br /> Number of lines_. '______ ____ ____ Length of each line..-�-C7-r_._._......Width of trench.-_-s .fi���_____________ <br /> �d� Type of filter maferial' ___Depth of filter material-. !f_____-_Total length_____s_ _`__,� <br /> Se age Pit: Distance to nearest well__I_0S?�_ _-__ Distance from foundation...................Distance to nearest lot line__-_____________- � <br /> Number of pits----------------------Lining material-----------------------Size: Dia meter-_-.33"r.......Depth---- .470-------___---_-- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___ _______________________________ <br /> ❑ Size: Diameter--------------------------- ----------Depth--------------------- -----------------------------Liquid Capacity----------------------------gal <br /> s. <br /> Privy: Distance from nearest well___--------------------------------_-------------Distance from nearest building--------------.._._.._-.---___.___-__--. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------.....---•-------- <br /> `)�1 <br /> Remodeling and/or`repairi (d tribe} .._ r •- __, ..._________ <br /> � .-�,,�--. - ,..� ; ,� ---------------------------------------------------------- <br /> ---------------------------------•-- ------------------------------------....-------------------------------------------------------------------------------------------------------•--------------------------------------- I <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 /> (Signed) _ _ 41_h. ----. c_.r fC"aC�--- ( - /� Contractor) <br /> BY� -------------------------------------------------- � (rifle)------------- ----------------­------- - - - ---------------- I <br /> (Plot plan, showing size of lot, location of system in relation wells, buildingk, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY E " -� ----------------------------------------- DATE-----? = ------------------- <br /> REVIEWEDBY----------------------------------------------- -----------------------------------------------------------•-- ... <br /> � -----� DATE_--•----•-------------------------- <br /> BUILDING PERMIT ISSUED------------------------------ ---`--------------------- <br /> •-- DATE------------------------------------------------------------- <br /> - <br /> Alterations and/or recommendaions:_ � --C Y <br /> ----------------------------- "�_ /h. �,• I <br /> ------------ -' � �- - �� . --------- - =" 2 <br /> c `TY 4 <br /> -. - <br /> FINAL INSPECTION BY------- - - -- ------ - ------------------------ � Date------ ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 304 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-59 2M 5-62 ATLAS , <br /> I ' <br />