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'K Vrrl(-t USt: - "-- •-•�•-- <br /> _0yk <br /> -- --- ---------- <br /> - <br /> I . <br /> u---------- <br /> = ' -.-_. 'v-a APPLICATION FOR SANITATION PERMIT Permit No. ..a4�4!`..... <br /> --------- '-------- --------- ------------ (Complete in Duplicate) <br /> This Permit-Ex fires 1 Year From Date Issued -D Issued <br /> { " ate I d <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 /> I , <br /> JOB ADDRESS AND LOCATION_ <br /> t <br /> Owner's Name_- 4 ._•--- F <br /> - --- ------- <br /> -- ----- ------- Phone <br /> --- ------ --- <br /> Address <br /> 72 ----- ------------------ :.. <br /> Contractor's Name �Yr� ��---._-- 5_ _ ----------•----___- •----•-4-----. Phone..--. <br /> -----------------------------•------- -- ------•---------- -•- ---- <br /> ------- --------------------------------------- it <br /> Installation will serve: Residence I� Apartment House Commercial,❑ Trailer Court ❑ Motel ❑ Other <br /> 1 ❑ <br /> Number of living units: .:-'( Number of bedrooms -__ Number of baths._. 9-- Lot size 7_X..-`Z 9 U <br /> �"P - - ----- ------------------- <br /> Water::Supply: Public system Community system ❑ Private ❑ <br /> Depth to Water Table -_ pft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe <br /> F Y ❑ 0-IFlardpan ❑ s <br /> Prenous Application Made: (If yes,date% -..--_- ) No New Cor.nstruction: Yes p5 No [❑ FHA/VA: Yes ❑ No,[ r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic' nk: Distance from nearest well_., _ --__Distance from foundai-ion-- --�._ __ 07�ki~o-� - <br /> -- --.Material-- <br /> - 5 <br /> k No. of comportmems----- ---------------5`ize-:--- --�(- X_- ---.Liquid depth. - t- <br /> t t x. -- -------------Capacity---k-0 <br /> Disposal Field: Distance from nearest well-.-._----_----_-Distance from foundation-, ...... Distance to nearest lot line__�?-"-�- _ <br /> [gJ Number of lines- ___.-.- -__ _-------Length of each line---7�-------------- <br /> .-.Width of french--,�- 9� " _ . p� <br /> T p e.of fitter materi6l'�T�_ a , <br /> � Yp - -_--.oma•-_f---_-=Dep#h of filter material-js(-,- � y <br /> t Total length ---- ---.----------- -.li <br /> Seepage It: + Distance to nearest weil_.L_�__ - �' f� ...� y <br /> ___D.istance from foundation_j-V-----------Distance to nearest lot line <br /> r ` - ------ <br /> Number of pits-----'-----------------Lining material -Q-( ---Size: Diameter--.31--f.__4.--------Depth------2--�-------------II <br /> r <br /> Cess ool: t i e <br /> p. Distance from nearest well :_Distance from foundation--------------------Lining material-------------------------------------- <br /> ------------ <br /> ❑ Size: Diameter-_ +€ -- _ i <br /> Privy: Distance from nearesfi well Depth--y_ __________ __D.istance from nearest rbui building g <br /> f ---• q P <br /> tY els <br /> to nearesfi <br /> lot line--- ------------------------ <br /> 1Remodeiing and/or repairing (descriJI),,--------------------------------- <br /> - ----------- l <br /> --------------------- <br /> _i -- <br /> ' - ------------------------------------------------------------------------------------ - ------ <br /> ----------------------- ----------------------------- '-----•--- <br /> --------------------- <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, andrules nd'regulatians of the San Joaquin Local Health District. <br /> �3 <br /> (Signed)---------- <br /> ---------------- [� <br /> - # ------------------ <br /> ------------------=-------------------------------- <br /> By:-------------------- ( ridloi Contractor) <br /> -------------------- ------- (Ttle) I <br /> (Plot plan, showing size of lot, location'of system in relafiontto wells,-.buildings, efc.,.can.be placed on reverse side). <br /> - - t - <br /> I FOR DEPARTMENT USE ONLY <br /> Of *r <br /> APPLICATION ACCEPTED BY - DATE_- 11 <br /> y� <br /> REVIEWEDBY---------------- -- -- ---- ----------- --- - ---•'------ ------------------ <br /> BUILDING <br /> -------- ------ <br /> - ----- ----- DATE------------------------------ <br /> - ------- - --------- -----------•------------•------ <br /> BUILDfNG PERMIT ISSUED------------------------------------------------------------------------------------------------- - -------- ----------------- - <br /> ----------------------------------------------------------------- ------. DATE-.. ij <br /> Alteratio s d/or r ommendatio l_ <br /> -------------- ----- <br /> - ------------------------------ ------ <br /> 4----------"--"------ ------------------------------------- <br /> -------•------------------------k- -- <br /> �' <br /> FINAL INSPECTION BY:..W=---- ' ,tom ---------- ' 2 �j` 6 <br /> :. --­----------- <br /> SAN <br /> Date- -- / -_ ---------------------------- <br /> 0 <br /> -------- --.- i <br /> ----- <br /> k SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naxelton Ave. 300 West Oak Streetj <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California Il <br /> ES 9 REVISED B-59 3M 3•'63 f.P.CD. :J <br />