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FQR OF -ICE USE: f -• <br /> / +r - - y <br /> APPLICATION FORxSANITATION PERMIT Permit No. <br /> M (Complete in Duplicate) T <br /> i a, Date Issued / <br /> _ --- This Permit Expires 1 Year From Date Issued <br />---------------------------- <br /> Application is4 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 Or inance No. 549. <br /> - <br /> 73 & e!��d <br /> JOB ADDRESS A DLO T N.. - --------------- <br /> = ----------------------- <br /> Q�j - -------------------- Phone-------------- ------ <br /> Owner's Nam <br /> Address_ 3 ------------------------------------------------------------------ ....................... .------------._-- <br /> r ■ — Gg <br /> Contractor's Name--------------- :_ --------- . Phone <br /> stallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ff � <br /> E , , <br /> ;�.;. Numbe of living units: 1----- Number of bedrooms -- Number of baths -/--- Loi size _ Q--Xa --------------------------- <br /> Water Supply: Public system Community system ❑ -Private.❑ Depth to Water Table sD ft. M <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loan ❑ Clay ❑ Adobet Hardpan ❑ <br /> Previous Application Made: (If yes,date/9S-7 -I---) No EI - New Construction: Yesi❑ No� FHA/VA: Yes ❑ No ❑ <br /> 'TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> : Y <br /> �. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) lw <br /> 00_Tank: Distance from nearest well-------- _______Distance from foundation----------- Materiel_________________________________________________ <br /> 7�— <br /> No. of compartments Size-----------=--------------- Liquid depth Capacity .1 <br /> Disposal Field: Distance from nearest well �_.Distance from foundation../O-__--.-__Distance to nearest lot line___Sr-____ <br /> ' Number of lines------ _____ Length of each line____, Q�___-_ ___-_.Widthlof trench-_ _ ------:3--- - ---- <br /> Typeof fi,,lfer...material-___..y: Q --_Depth of filter material___ __________Total length----------------------_—-- - ----- <br /> --------- <br /> --- 9 <br /> - � ,�,"� f <br /> Seepage Pit: Distance to nearest wel _L!�'r* --Distance f om fo ndation_ Q______-_.Distance to nearest lot line_______________ Vf <br /> # Numbers of pits- -----:----- <br /> ��.• .� I <br /> Lining material_-- -- ----- Size: Diameter-3. -- --Deptn---- - ------------------ �4 <br /> A. <br /> Cesspool: ''Distance fiam nearest,.well---------------_`;Distance from foundation-__-------.____-_-_-Lining#material____._-_._.___._-____________._____ (1'{ <br /> El { Size:,Diameter-=---.- ---------'----�-------------P eptly- ----------- -- --------Liquid Capacity gals. <br /> ------------- - -- ---- - <br /> Privy: f Distance-from nearest well------------------------------------------- ----Distance from nearest building---------------- ----------------. <br /> I I <br /> ❑ ) Distance to nearest lot line________________ _ <br /> d/or`re airin• .describe � -� -------------------------------- <br /> Remodelin an _.__--__---------------------------- <br /> I a #-------- ---------�----- <br /> ----------------------------------------------------- =_ <br /> i <br /> ! k, <br /> - -- - <br /> ----- - -------------------------------------------------------- <br /> 00 <br /> I <br /> I hereby cert' that I have prepared this application and that the work=will,be`done in accordance with San Joaquin County <br /> ordinances, St I ws, an4 rules and regulations of the San Joaquin Local Health District.-------------------------------- -- _ / Contractor <br /> (Signed)_ --- --- ---Ir=_ ---- -- wrier and or ) <br /> By:-- ----------------------------=-------_-- - ----- - --------------------------(Title}-- , -------------------- -------- - -- -- <br /> (Plot plan, showing-size of lot, location of system in relati wells, buildings, etc., can be plate on reverse side). <br /> t - <br /> € a <br /> FOR R DEPARTMENT USE ONLY «..... <br /> APPLICATION ACCEPTED BY - -------------- — ------------- <br /> ­ . --.... R,..._.�., <br /> DATE-. r . <br /> REVIEWEDBY--------- -------------------------------------------------------------------- ----------------------------•--------------- DATE° <br /> BUILDING PERMIT-11-SSUED------ :=. ' ----- -- ------------ - �------------ --- -------- DATE------------------------------------------------------------- <br /> BUILDING <br /> and/or,recommendations:______`4Z, - ------=-� �r------_ �_ ` ^` -`------4 <br /> ---------------------�#, r{'" ti""G ":L G --z---- - _!_, ------ - ------------------------------------------_t --------------------------------------------- <br /> 1.h <br /> -------------------------------------------- <br /> y.h <br /> ---------- <br /> ------------------------ti---------------•----------------------------------- <br /> r f�. <br /> ------•------------------- ---------------•--- <br /> FINAL INSPECTION BY:_ ...........rAN <br /> �!'' --- Date__.-------__` <br /> AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 3ak Street 124 Sycamore Street 205 West 9th Street <br /> i Stockton,California Lodi,California Manrecar California Tracy,California <br /> ES 9 REVISED a-S9 3M 3-'63 f.P.CC. - <br /> t <br />