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7 <br /> 7 <br /> Permit No. ... .....7 AP.CATION FOR SANITATION IRM <br /> ...... (Complete in Duplicate) <br /> I-- <br /> ---------------- .......... This Permit Expires 1 Year From Date Issued <br /> Date Issued ---- <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 /> JOB ADDRESS AND TION --------------_---_-----------------------------------------------------------_ <br /> Owner's Name. -------------------------- ---------------------I---------------------------------------- Phone.................__..........._ <br /> Address--- .169;9�- _----_---- ---------------------- ------------- ------ -- -----------------------------------------------------------------------------11-1--------1-1"*-------I-----­ <br /> - 4 L Phone................................... <br /> Contractor's Name......... - ---------------- -- ------------- -- -------- <br /> Installation will serve: Residence U?'Apartment House D Commercial C-C i X Motel 0 Other [I <br /> Number of living units: ../-. Number of bedrooms _R;Z_ Number of baths .,I-- Lot size IAQ4.4- <br /> Wafer <br /> 4.4-Wafer Supply: Public system El Community system n Private U!1'16epth to Water Table AP4. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam [] Clay Loam El Clay 0 Adobe M--'PHardpan 0 <br /> Previous Application Made: (if yes,date._._..._....._-) No � New Construction: Yes E] No ga" FHA/VA: Yes E] No ®— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S-ptic Tank: Distance from nearest well-Z40- Distance from foundation- M a I-i a ,,e g�,e-ie.4(-:1 <br /> I 1� �p --- ------ - ------- <br /> OX_�X_M--------Liquid depth__jV.j."___ -_ - ty_A0�_­_'... <br /> No. of compartments--_Vj._ .--Siz,w-- -- ---- Capaci <br /> Disposal Field: Distance from nearest well-,IA40'-Distance from foundation__o/e__/......Distance to nearest lot line.A" --------- <br /> Number of lines.....,_.__....... - Length of each line_.1A010P-------_----Width of trench-A!...........**...........­ (Q <br /> W ---- ...................... <br /> Type of filter me _____D.pth of filter material----le-."' ----Total length.... <br /> Seepage Pit: Distance to nearest well....1,W.....Distance fr-Qm foqndation___,_?P......D�i�se to nearest lot line......... C\ <br /> ....Size: Diameter-S.9 ... --------Depth_.x1J,_..�............ <br /> Number of pits.- -------Lining material---XPA*Or <br /> Cesspool: Distance from nearest well.................Distance from foundation --------------- Lining material..__.... .......................... <br /> 0Size: Diameter........_.....---------------- ------..._..De pth--------------------------------- ----_------------Liquid Capacity....-------------------.....gals. <br /> Privy: Distance from nearest well------------- . .... ........ . .._-Distance from nearest building........._..._------_---_------------. <br /> Distance to nearest lot line......... -------- .. ......... ---- --- ..... ---------------------------------- <br /> - ----------------------------------- ------ ------------- <br /> ......41 <br /> Remodeling and/oArepairing (cleoibe):_ ----------- <br /> AM ---------------------------------- ......... <br /> - --- --------- ------------------------------------------------- <br /> .................. <br /> forprepared - ---------- V-0--- <br /> ;h+i,, pFIic'ati,n and f.hat the work will 6 done:in ac ante with San Joaquin County <br /> I hereby ctify4hat olvx, <br /> ordinances, State laws, an 5�rules and regulations of the San Joaquin Local Health District. <br /> (Signed).......... .....................................!--(Q Sommeend;lCor Contractor) <br /> tion wells, 12 <br /> ings efc can be plef.2d�O��T.vrs. side) <br /> By:.---------L_ZTloe� - - ---------(rifle)... ------ -- .... .. <br /> ...................................... , _ ------ I <br /> (Plot plan, showing size of lot, location of system in via, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... - - ----------- ---------------------------------------- DATE.. Z__ <br /> >--­-Z-7.. ...................... <br /> REVIEWED BY----...------------------_--------------__...-.. -------------- ----------------- -- ------------------ ...... .... DATE-----------------------------------------......_........ <br /> ............... <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------- - ---- - DATE................-------------------------------------------- <br /> Alterations and/or ----—-- _i,,�---------- <br /> ---- - ------- ......... ....................................... <br /> .........!L!A, .. <br /> CO. $CLZA. <br /> _------------ <br /> .............. .................... <br /> .. - ........ <br /> ccE . ..... <br /> ................. ................. ....­ ­__....... ....... .......... -------------------­- ----------- ............................................................... .. <br /> ...... ..... ...................... ...... ... ... ........ ................_­------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.... ........._ ___......._.. _ Date__ ------............._..----.`- <br /> SAN <br /> ­--------------------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wool Oak Sn,**11 124 Sycamore Street 205 WrIa 9th Street <br /> Stockton,California Lodi, California Manteca, California Tracy,California <br /> ED 9 REVISED 8-59 2M 5-61 ATLAS <br />