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rVK ui`-NC.t USt: Ily Cofo o` <br /> 63 <br /> ------------------ <br /> �y ------ ..--_.� (,._�LICATION FOR SANITATION PEI: F Permit No. <br /> -------••----- ...... (Complete-in Duplicate) r� <br /> This Permit Expires 1 Year From Date Issue '-= Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct an isfall`the wow herein described. <br /> This application is made in compliance /with County Ordinance No. 549. <br /> JOB ADDRESS ANJO L CATION-.- .f .!-.L �.... .. <br /> ------------------------------------ <br /> - <br /> Owner's Name. - ..--..- I...---•-• . Phone... 2 7-W <br /> ...... -•--- •----------------- --------------- <br /> -- <br /> 5 -4-5-,-1-1--M---­------­---------------- <br /> ------ _ <br /> Contractor's Name-,..- ............. ----- -- Phone-.--.: <br /> ----------------------------------------- -----------•---------- __------ <br /> 3; Installation will serve: Residence [r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> 3 Number of living units: .-1.-_-- Number of bedrooms ........ Number of baths--------- Lot sire------ --- ------- ---.--- <br /> Water Supply: Public system ❑ Community system ❑ P6va to k2-Depth to Water Table ...... - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[}Hardpan ❑ <br /> Previous Application Made: (If yes,date--................. ) No ❑' New Construction: Yes ❑ No [�t-_FHA/VA Yes,K No <br />` TYPE OF INSTALLATION AND SPECIFICATIONS: C�`rPp <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tankt Distance from nearest well-----------------Distance from foundation-------------------Material ...--.--..-..-.--.--_--....-...-...-__-..-..---. <br /> No. of compartments.... ......_ <br /> ((�_�� -Size--------- -----•---- -----------Liquid depth......... .---- - --.- - Capacity----- ---------------• <br /> Disposal Field: f Distance from nearest well------ ----------Distance from foundation--------------------Distance to nearest lot line------------- -- \ <br />` ❑ � Number it lines -- --- -----.Length of each line-- --------- --------------.Width of trench..-................-- �------------ <br /> e of <br /> Seepage Pit: D�sptancef tloeneaaestrlwlelL.fQC---..__..... eo#h of filter ma#eriaL___---------- ------Total leng#h........-......---_--.-.-.---- --.- ---- <br /> F . <br /> I Distance �from foundation___4_ #-------Distance to nearest lot line_--j.��-.• 0 <br /> Number of pits... .- Lining material...-_-_./{ .LIC.r. Size. Diameter--_Z..._.___- Depth... ......--- <br /> Cesspool:_ Distance from nearest well ...... ........Distance from foundation ---------------- ..Lining material__----------------- <br /> [❑ Size: Diameter. .. ........... <br /> ......... ......Depth. -. ..- -- -...- •--------------------- -----Liquid Capacity--.---�--•-----------------•gals. <br /> Privy: Distance from nearest well........................ . ....._Distance from nearest buildiEl ns.__..-Distance to nearest lot fine ------ ..-_--------.-------......... <br /> ---------------- <br /> Remodeling and/or repairing (describe):_---...,'" 'G €�[..- .- - <br /> -- -�7 <br /> ....�` ----- --------------------------------------------------------------- <br /> ...... . . . ... .. .... ---- ---.------- ............... `.-------------------------------------.--------------------..-_-- --------------------- - - <br /> -:----•--------------- ----- <br /> I hereby certiVIhave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State and re la ' ns of the San Joaquin Local Health District. <br /> (Signed)_---_-• -------- ------------ •- .....---- --------- ........--------------- -•------------------------- -------------------.(Owner and/or Contractor) <br /> By:.. ---------------------- --..................... .---.--.. -- . -•--- -----------(Title)----------------- -------- .......------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_..-----------r7'/ DATE. f1� �� �� I <br /> ---------- -- - - -----•-------------- <br /> REVIEWED BY ----------------- --- - ------------- -- - ------------------------------------------------- DATE----•------------ <br /> BUILDING PERMIT ISSUED-------- -- --••------------------•--- ---------•---_.. DATE-.------------------------- - - - - z <br /> Alterationsd/o recommen ans --..--......... _ _ <br /> -- �-------- -•,,G-'ti�. : ----------- ------------------------------------- <br /> ------•-----•--- -••------•-•----------- -------------•- ---•---•--------- -- - •----• -•-•--- -• --.-.-------_ <br /> .-----•--- ------•---- -- ------------- -------------------------------------------------------------- ----•---•-- ............................ <br /> ............. •--------------- ---------- -............. <br /> . .............. ...... .... . ..--- <br /> FINAL INSPECTION BY:............ <br /> ............................. .......... Date-------��--=---��--=--f°�--�-- ---�-�-�- ------ ------- • <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave, 300 West oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi California Manteca,California Tracy, California <br /> E.H.9 2M 1-67 Vanguard Press <br />