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FOR OFFICE USE: <br /> ----------------------- ------------ ------------- t No. <br /> APPLICATION FOR SANITAT16N PERMIT Permit <br /> ------------- ------------------------------ <br /> -3 <br /> --------------------- --------------------- (Complete in Duplicate) Date issued --- <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. <br /> 'AA1 Al, 81>._� <br /> --------------- <br /> VE-A---/y_ --- <br /> ft.�L�r-----11/v <br /> JOB ADDRESS. AND LOCATIONI.�I.P I <br /> Owner's Name..----------- NIN E-D-,Y- ------------------------------------------------------- ---- <br /> -------- Phone---------------------------------- <br /> --— --- --- - ------------------------------------------- <br /> Address--------------­- --------- <br /> Contractor's'Name ----------------------------- <br /> Trailer Court [3 Motel [3 Other 0 <br /> House El Commercial 0 <br /> Installation will serve: Residence yn <br /> VAparTmenf -;—? Lot size ... A.iC_RX-_�_ ------------------- <br /> Number.of living units; Number of bedrooms _S--- Number baths <br /> ;;/ ft <br /> D <br /> Water Supply: Public system" 0 Community system D Privateepth TO Water Table <br /> m 0 Clay [] Adobe[3 Hard an 0 <br /> Character of sail.to a-depth of-34sefi-Sand W_�&ravelIg Sandy Loam D Clay Loa <br /> Previous Applicati 7­777�. Na New Construction: Yes 19-"No [I FHA/VA: Yes No C] <br /> e <br /> TYPE-OF-INSTALLATION-AND'-SPECIFICATIONS: <br /> (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) <br /> a- from foundation,.- ------v--.Ma ria"---------------- <br /> S1�ank: Distance from nearest well__- Di t n(;e <br /> Liquid dep� ------ capciy......------------- <br /> -No. of compartments-..---- ..... 1h 5— <br /> Diftance from foundation_..._0- ---------Distance to nearest lot ling._ ........... <br /> Disposal yield- Distance from neares�rte,111_157_0___ <br /> Number of lines.-------- --------------------L Lengtk of each, line.... _ 5-0-L.Width of trench---- <br /> t <br /> ------------ <br /> -------Total length__________.00------ <br /> Type of filter material._-----6epfh of filter material <br /> 1 nce from foundation....................Distance to nearest lot line----------------N�- <br /> is D <br /> Seepage Pit-. Distance.to nearest well-------------------- -D fa <br /> Number of pits-------------------- Lining material----------------------Size: Diameter------- ----------- Depth----------------------------- - <br /> ❑ <br /> Cesspool: Distance from nearest well_____________ __Disftance from foundation-------------------Lining material--------------------------w---------- <br /> ❑ I A 'VSize: Diameter------------------ -------- Liquid Capacity------------------------ <br /> - ---------------------------------------------------- <br /> gals <br /> .--Disfence�-frorn-nearest-building----------------------------------------- <br /> earestwell--------------T-----------------(----- ------- <br /> Privy: Distance from n 0 Distance to nearest lot line..-------- -------------- - - ------------------------------------ <br /> --------- ... <br /> ----------- <br /> Remodeling and/or repairing (describe):____A_'_*Z <br /> A.0!ft,.........­ <br /> � ,_ <br /> .................. <br /> --------------------------- <br /> ----------­-------------I----------------------------------- ---------k---- ----------- ------------------- ...el-4,4,----------------------------­_ <br /> ------------------ f -_ .!------------------------------------------------------------- <br /> -----------------------------......................•------------------------------.... --------------------------------------------------------------- ------- -----I with San Joaquin Couifnty ,' <br /> I hereby certify that I have red this application and that the work will be done in accordance w <br /> pr 0 "gU T <br /> of the San Joaq'uin-Local-Health-District: <br /> ordinances, State Ws, and rul' and regulation ion <br /> ;/L_ __ __ _ r)k\ <br /> ------ --------------------W----------------(Owner and/or Contractor) <br /> ffjt'm��` -4.. -- ------------ <br /> (signed)-----uj - __ . - r . <br /> -----------------W-------(Title)..........................------------------ -- ----- -------- <br /> ----------­--­---W--------­--------------- ------------ ------------- laced on reverse side). <br /> (Plot plan, showing size of lot, location of system in,relation to wells, buildings, etc., can be p <br /> -* ' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ---------------------- ----------------------------- --------- DATE-----------?_" -3-------------- <br /> REVIEWED <br /> 3-------------- <br /> REVIEWED BY.-. -----------•---------------------------- <br /> --------------------W--------------------I------- DATE-------------•- --------------------------------------- <br /> - <br /> -------------­ ------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED----------'------------------------- DATE <br /> - <br /> Alterations and/or recommendations:----------w-w------ ----------- -- ------------------------------------- <br /> .41 -------------------­--­---- --I-------------------------------I---------------_----------- <br /> ...........I---------------------------------------- -------------------------------------------------------- <br /> --------------------------------- ------------ ------- --- --- ------------------ - - ---------------I--------------------------------W-----------------------------------------------W------------------ <br /> ------------------------ -----W-----------------------------------------W-------------------------------- <br /> -------------I--------------_­­­­------------ --- ---- --- ----------- ----- <br /> ---------- ------------------- --------------------------- <br /> ------------- --- ---- ----------------------------W............ <br /> FINAL INS LIO N 8 Date--------- A5 -------- ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak STr*ot 124 sycamore street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />