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�i�J6--------- ----3 fs 3U <br /> .._'..._.,: ------------............._. .__- A4,XICATION FOR SANITATION PER6.i Permit No. . _.._... ._/.,� <br /> ------------------------------------ ------------_- (Complete in Dupricafe) <br /> Dote Issued <br /> This Permit Expires 1 Year From Date Issued __...1.G....._ <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 LOCATION----- ------- QL . , lrlTfai✓ --------------•-••---•---•-••-----------------------•-----....-•---- <br /> s' Owner's Name........... �� + '� J ---- <br /> E � ------- ------ . . ....................................... Phone„......--....--.............. <br /> Address--------------...... �o.J-...... ------••----------------------•----------- <br /> ............................_. .... <br /> is. Contractor's Name--- - ..- d ...........................................-................................... Phone...-......_....- ,y - <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [I Motel [I Other <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ........ Lot size ._`_.__. ..4_11C_,P,F ----------- <br /> se” Water Supply: Public system C] Community system E] private �th To Water Table 7& ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> ` Previous Application Made: (If yes,date...._.__-_.._-.--I No New Construction: Yes ❑ No 0;--+I:rA/VA: Yes ❑ No'19--� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> p ��� ._./.�..........Material.___.(F�.�.Y/ G-�--.-__ <br /> Septic k: No. of compartments±_WB a_._._.Sireance from foundationLiquid depth----1�!�r..___..Capeuty......-�------ <br /> Dis TooJs'al ad: Distance from nearest well. . ._.__...Distance from foundat•on—1®_-------Distance to nearest lot line---.se��.... <br /> ea Le Number of lines---------1........................Length of each line-.6.0......__._..._.._.Width of trench..-�=-y---_----..._.-...... <br /> Type of filter material_... 1 _..Depth of filter material._L.P__��_._.--Total length....=e_._------................. ... Q <br /> Seepage Pit: Distance to nearest well.....----------------Distance from foundation.......--.----_..Distance to nearest lot line............. <br /> ` ❑ Number of pits----------------_-----Lining material-----------------------Size: Diameter Depth------------_................. <br /> .. <br /> Cesspool: Distance from nearest well......... ----...Distance from foundation....................Lining material------------------------------...._ <br /> ❑ Size: Diameter----__------------------------------Depth-----------------------------------------------....Liquid Capacity-----....................gals. <br /> ts� Privy: Distance from nearest well----.__.._------.----------_------------------:Distance from nearest building----------------._................... <br /> ❑ Distance to nearest lot line..................._.___ .__._.__..._.....,_ <br /> Remodelingand/or repairing describe :-___._._......� ._.. �}_ _.. <br /> . .----------------------------------'-----------------------------------------------............................---------------------_----"------------......-............-•-------- ------ <br /> r I hereby certify that I have pre ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State �, and a ulations of the San Joaquin Local Health District. <br /> (Signed)--------- L -- - U- ---- -- ----- -'-- --- ----.----------'-----------------------.._..--J_ie----- ---- ..(Owner and/or C tractor) <br /> r <br /> By:-........-----'..... - -­------------- - - (Tite)- <br /> (Plat plan, showing size location of system in relation to wells, buildings, etc., can be place on reverse side). k <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED DATE... ./e... .__.-.._..__._.__.__. <br /> REVIEWEDBY----------------------------- ----------_--------------------- -----............... •......_----- ----'-- DATE...................._-----------....................... <br /> BUILDING PERMIT ISSUED---------............... ---...-_--------------- DATE--- ........................_----------___-------- <br /> Alterations and/or recommendation _ _..... �s .................................----.. <br /> y <br /> -----------•------------•---------..........----------------------------------------------------------------------------...... ----............-------------.....---'- --......------......---. <br /> -................................ ............................... -- ....................--.................... . - .---------............ <br /> FINAL INSPECTION BY:_l�.Y.+ a � - ... Date_../ -- ---------•----'�---------`----------------------- <br /> /( SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stmt 300 Wut Oak Srrvt 124 Symrnore Street ;05 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracyf California <br /> ES 9 REVISED 8-59 214 5-62 ATLAS e <br />