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FOR OFFICE USE: <br /> - <br /> --------- ---------...... ------ --------------------- <br /> -------------- -- ----------------- --------- APPLICATION FOR'SANITATION PERMIT Permit NO. <br /> .. J-7 ... ... --------- <br /> (Complete in Duplicate) 117 V <br /> 'This Permit Expires I Year From Ddte Issued Date Issued"[Complete <br /> ---- <br /> Application is hereby made to the San Joaquin Local Health District for apermit to construct and install the work herein desc ibed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> r <br /> JOB ADDRESS AND' OCA 30N---.-1 <br /> -- ---- -------- --------- --- ------ <br /> Owner's Name---------'- -11 <br /> -- --------- - --- --- ------------ -------------------------------------------- Ph o-'n e- ----------t------------ -------- <br /> ------- --- -- ------ -- ---- --------- <br /> Address----------------- ---- -------- ---- <br /> Contraictor's Name-- on <br /> -------------------------------------- h f ------- <br /> Installation will serve: 'Residence ❑ Apartment House E] Commercial E] Trailer Court ❑ Motel Other ❑ <br /> Number of living units: Number of bedroomsA---- <br /> Numberof-bafhs Lot size ---------Ll-------- <br /> Water Supply: Public system Ej Coinmunify system E] Private Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: (Sand E] Gravel Ejj'�-Sa'!'dy.Loam' ❑ C14 Loam 10 Clay El Adobe E]4. Hardpan F] <br /> j � .."N if <br /> 0- Applicafioh Made:' (If yes,� N&'Z't�'New­ConstruEf ion.-Yes-10 No 0 --FHA/VA-Yes-ff,-N -E] <br /> Preyi us 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is ava'ila-61e within 200 feet.) <br /> Septic Tank: VllDistalnce'from nearest well--/S-bf---- Distance romoudation Materiai- ---- <br /> No. of co�npartmenfs... Siz`e4At543R-- Liqui depth---------------- ---------Capacity----- --------i-------- <br /> -Aj 9 <br /> Disposal Field: D ance from nearestisfance--frcim'fzr�dfio,--gb./-A24-.--.Disfance to nearest lof,)ine/g�W, <br /> Number'-O'f 1 knes-1.---------11- ----- Length of each line...... -------------Width of french-Q--44--------- 11------- <br /> Type of filter.mafeiial- Depth of filter material. - -------- ---Total length-757-Av------------U-1 <br /> Seej�'aqe Pit: Distance to nearest well.16g4L:Distance fro fo dation. )�� C"W <br /> To 9.9-------------Distance to nearest lie ---------- <br /> ,W <br /> IL, <br /> Number of pits__:../-------------Lining material- w VU-Size: Diameter-4fAR' e Z-- ------- <br /> :# 41.*-- ---------D pfh-!' -.� 11 tA <br /> Cesspool. Distance from nearest well_________________Distance from foundation---------------------Lining material- ------------- <br /> Size: Diameter-----------------------I----------- <br /> ----Depth---------- ------------------------------------------Liquid Capacity-=----•-I------------ !gals. <br /> Privy Distance from nearest well-------------------------------------_-----.----Distance from nearest <br /> ❑ Distance to nearest lot line.------- ------------ ------ <br /> -------------------------------- <br /> Rem 6deling and/or repairing (describe):--------------------- ----------------------------------------------------------------- <br /> ------------------- I <br /> -- ---'--7-------------- ------- <br /> --------------------------------I----------------------------w--------------------------------------------------- ------------------------------I---------------------------------- ---------------- <br /> - ------------------------------------------------- ------------------ --------------------------------------------------------------------------4--------------------------_--------------- <br /> ---- ----------------------------------------- ----------------------- ------- ----------------------------- ------_--------------------------------------------------=----------- <br /> ,--i, -I <br /> �l hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> "'L <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> r <br /> ll <br /> By:----- <br /> 04-6--e F,-d/dVr-C a- <br /> �Sign6d)- --- ----------- <br /> 7D76�r c or <br /> By:------ d L-,�Ox 1� <br /> -----------(Title)------------ --------------- <br /> - ---------- --------------------------------- --------------- - - ------ <br /> ------- <br /> (Plot plan, showing size of lot, location of system iy relation o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- <br /> ------------------------------------------------------------------ DATE----------- <br /> REVIEWED BY------------------------- ---------- ------ K-ImCK-DATE----------------- ------------------ --- T------ <br /> t-ff-1 <br /> BUILDING PERMIT ISSUED__.__._-------- <br /> ------ --------- -- ------ -------------= DATE------ - <br /> Alterafions and/or'recommendations <br /> ---------------- ----------------------- -------- ----- <br /> ------------------------------------------------- ------ <br /> P ------En -A.------------0- ---- --- ------ <br /> ------------------------------------------------------(-?�C---V1V1F,9- iv <br /> ----------------- <br /> ......'--=------------------------------------------------ --- ---- - ---------------------------------- It <br /> - -- ---------------- ---------------------------------- --------------------- ------- ------ <br /> ----------------- -------------------- ----------- ----- ------- ------------------------ ------ -7------- ------------------------------------------------------------------------ ------------- <br /> PINAL INSP - --- ------ ----64b- Date------------- - -------/1157= <br /> x-------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT k <br /> 1601 E.Maxellon 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.F.C13. <br />