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FOR QFFI E •SE:_._. ..-.___�714 <br /> rC.3..__..> ;_ c) APPLICATION FOR SANITATION PERMIT Permit No. ..� 1� <br /> I + (Complete in Duplicate) /�— <br /> ermft Expires i`Year From Date Issued Date Issued .............. 6 Z. <br /> --- This P' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> t This application .is made in compliance with CounOrdinance No. 549. ecv^�s-roc,k R4, •/-c, .fir'--s'c�� <br /> e-Lf tri /j- ��.c Ft. E_ T/,�caV no2Tr� ons ccs'E�s�i �,�- <br /> JOB ADDRESS AND LOCATION3...dc?f1' a6 y----------------":..._...._ . <br /> ----....----•----•--. •---..I...... ............................ <br /> x N,::. d OF 15'®~2.2? 2 .3 <br /> ' <br /> Owner's Name-.. Rig?.. '��Nfi,t�Vl!! ------•--•- _. Phone/../a: 6..R._._.7......... <br /> Address........................ <br /> :..... ............................... •_... <br /> ---•-•--.._........_.........---•-•---. <br /> Contractor's Name ...... '.r�z.:..e1%.,6" f..i �£t2✓l�.S....-)f:��l�.!:-°........................... Phone.. ---............................. <br /> Installation will serve: Residence I- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..`-___ Number of bedrooms Number of baths __?�... Lot size ___}:C2____5�_c�:2E............................... <br /> Water Supply: Public system ® Community system [I a Private [Depth To Water Table .6�. ft, <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Q' Clay Loam ❑ Clay ❑ Adobe❑ Hardpan❑ <br /> Previous Applicatlon Made. (If yes,date_-__--------------) No Z' New Construction: Yes ❑ No E>'f FHA/VA: Yes ❑ No F?r <br /> ' TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o <br /> 99 <br /> Septic Tank: Distance from nearest well.................Distance from foundation.................-Material_____----___--_............__....____... __.. <br /> No, of compartments ------------------ S --------------------- ..Liquid depth.- Capacity--------•---•-•--_® C1117-- - ..,.. <br /> Disposal Field: Distance from nearest well...SQ_r._-_Distance from foundation____/.P............Distance to nearest lot line.//_°.... <br /> Number of lines.............1-------- ...........Length of each line__.-_.3 _`.;..._._.....Width of trench...... .`......_............ <br /> 4a" Type`mf filter material..""_..` Depth of filter material....../4F_`__.__.-Total length__.________ ______________________ <br /> i A � <br /> Seepage PiDistance to nearest well..-.t 4Y?..r........Distance from foundation._.d':.'...e........Distance to nearest lot line... ...... (0 <br /> R Number of pits---..-___i-----------Lining material....N?O ___-Size: Diameter.__.��..___...__Depth---------�6 - ___......_. <br /> J F <br /> Cesspool: Distance from nearest well.................Distance from foundation......._...........-Lining material-----_-----------.................... <br /> �" ❑ Siwe Diameter------ -----..-----------------.._.Depth...........­­---------------- Capacity............................gals. <br /> 1 <br /> Privy: Distance from nearest well-------------------........................___..Distance from nearest building-----------------------_-_--__--.. <br /> ® Distance to nearest lot line_. <br /> Remodeling and/or repairing (describe):...------..42W.-------,tit_ .-----•••- ••------ °.......................................... <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, and rules and regulations of the San Joaquin Local Health District. <br /> ' (Signed)....,. t9. �"�•= .... , .............s.•....°. .._.......... ( n®N and/or Contractor) <br /> Ry:--------- ---- --- - ------------------------------------••-••-•----------- -(itis)- <br /> ' (Plot plan, showing size,of It t, location of system in relation fo wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ' <br /> APPLICATION ACCEPTED BY..... Gt a s-�.: :............<. ..-----..._.---- .. <br /> • /•-m---•- -• DATE---•�-------------=---�.-.:..,�.... ._....------....-•-- <br /> REVIEWEDBY-------. ------- -------- -------------------------------------------------------------•--------------------------- DATE.•- .... <br /> BUILDING PERMIT ISSUED......-----------------------------....._._-•-__ DATE.__.-••-•--•- <br /> - --->-.___._..-•------•---•-•---------------•-- -• <br /> Alterations an reca mend'ation - --------_-- -• �!�--�--L7. ----.- -- - -- L ! <br /> ' —��d ................................................................. ...................................... <br /> — -` �. <br /> _.3 i <br /> ---...-----•••---- ---••---------••-----•-••-•---••-• --- --------••-----------------------------------------------------------------­­..........................................--------.................. <br /> .....................................................................................................••....................................... ........ ------- <br /> --------•------------------------------------Q.---------........._.......---- <br /> FINAL INSPECTION BY:.` * L ` __ Date------ � '`. —.. �� <br /> ,... <br /> ' S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South/American Street 30 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8=59 2M 5=52 ATLAS <br /> R <br />