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------------------------------------___------------- <br /> ------------- --- AF CATION FOR SANITATION PERNn Permit No. .�:5_.__ 5` <br /> --------- --------------- <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued /- -:-_�_fr--- 1` <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work rein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION _ ----- ; p_ ._ .._.. ' -� <br /> sI ------ .._��...._�-- --------------�- <br /> Owner's Name t_ _ =il j— N__4U_&_ --fs------------ . <br /> •------------ -----•-----.... Ph <br /> _ . one..---•-------••--------•-----•-••--- <br /> Address----- � __ _ 94 �! <br /> Contractor's Name -- � �,^ ° . -E3. -� i <br /> -- - 'P .- Pho........ <br /> e�. .�. <br /> --... <br /> Installation will serve: Residence Apartment House 0 Commercial ❑ ' Trailer Court ❑ Motel ® Other ❑ <br /> Number of livi.g units:; -�:_ Number of bedrooms _'Z Num��D!ppfh <br /> baths --I-___ Lot size ___ r - _.-__-•---- <br /> Water Supply: Public.system—G�orrrrrlt�n ' s s emty, y ❑ Private To Water Table :?�-- ft. <br /> Character of soil to a depth of 3 feet: Sand �1 avel, - Sa nd Loam <br /> � y } �Cfay Loam ❑ �lay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date___................} No <br /> [ New Construction: Yes No ❑ FHA/VA: Yes ❑ No f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> [� No. of tom artme t _.. ._____.__: � � <br /> Septic Tank: Distance from nearest well__,__._-______D tante from foundation___ <br /> Ma a tal__._tlS�' _...__. <br /> p �-- ----- iz _.. .� =�uid depth--•---- ------ Capacity._ .. <br /> Disposal Field: Distance from nearesf'Well �' `-bis}ante from fo ndation_l Mu l _ -- -- <br /> �- --------Distance to nearest lo <br /> t line....,.:...Letgth of each lite------ ----------Width of trench------1. Typeof filer mater <br /> of filter material_ " ' <br /> ,P - �--------•--Total length----_------ <br /> Pit: Distance to nearest w}.'eIL_____________________Distance from foundation __...:______.__-.Distance to nearest lot line___._._____._.-_. <br /> t <br /> €] t Number of pits- Linin material. Size: Di meter--------------•-_---.Depth----------------•-------- ------ <br /> Lining 0j <br /> ❑ <br /> r11 e' 17iamefef De th. = .Lining material ---------•--------------•------ - <br /> Cess ool: tstant from nearest wall__---------------Distance from foundation_---- <br /> 4 <br /> J; p Liquid Capacity---------------------------gals. --� <br /> Privy: '� ' Distance from nearest well____________________ ---------------- <br /> ------------------------ Distance from nearest buildin <br /> g ------------•--•------- <br /> ❑ !. Distance to nearest I- _ <br /> -t line---------- --- <br /> Remodeling and/ r repairing (describe__________________ ---------- <br /> --- -------•---------• ----••-----•------------------------- <br /> ---------------------------------•--- -----•------------------• - . . --...- <br /> -------•---------- <br /> ___ <br /> ---------------------------------- _ 1____________________________________________________________--------------_--- ] <br /> I hereby certify that I have prepared this application Indtho the work will be cone`in accordance with San Joaquin County <br /> ordinances, State Iavii, and rules an regulations of the S n JoaqGin Local Health Di trict. <br /> (Signed)..__ ` _ G'�� � --,�`G'� iie-�� [ / Contractor) <br /> --._{ __ <br /> ----- -- --_ --.-. <br /> r ... - ---- ----------------Owner and/or <br /> Yi• y -------... = (.Title} M <br /> B ' <br /> (Piot pi n% showing size of lot, location of system in relation to wja, buildi gs c. ca be placed on reverse side). <br /> l <br /> FOR DI±PARTMENT USEONLY j <br /> APPLICATION ACCEPTED BY---------- - ,.----------" f_ <br /> -------------- DATE------ • �+ <br /> REVIEWEDBY--------------------------------------------- -- --------------------.-. DATE--- ---- •- ----------------------- <br /> -- ------------ - - <br /> BUILDING�PERM SSI ED -=--- - ; �. .� --. -DATE-=--=•�.t---------------- -----••-- ----- <br /> Alterations and/or recommendations: -'���"�";�'"""°" "'� - <br /> .-------••--------•--- ----- �, <br /> --•------- --------•- --- <br /> .•--------- ------------------- <br /> R <br /> FINAL INSPECTIO v -I; Date__. " - � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> ES 9 REVISED a-59 2M 5-62 ATLAS <br />