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fry APPLICATION FOR SANITATION PERMIT Permit NO. .._�Q_1 .. <br /> Q . (Complete in Duplicate) ��ls <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.t <br /> This application is made in compliance with Co>untyf Ordinance No. 549. / �/��,�r��,v� jT) <br /> JOB ADDRESS AND OCATION...,III4 j1 .._._J.f1�%f S.c ...-Q�L-- S S1.11 .. ...,r�'Gs►.!X 1..4..--------- <br /> Owner's Name--- -a •' j�'�jlld !^S----------- ------------------------------------------------------ ._ .....-- - ----. Phone.................................... <br /> Address..--------, :l.:5..+?_ h,p - - ' <br /> Contractor's Name--------- - - LL�O.T9-----------------------.__--------- ---------------- ............................................ Phone....................................... <br /> Installation will some: Residence B^• Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .%�_._ Number of bedrooms . .. Number of baths Gam. Lot size _. __Ale� ------------------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table�.�• 'ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam R+-Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Ej� New Construction: Yes ❑i'No ❑ FHA/VA: Yes R''No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_,,./d`_..'Distance from foundation__/4.*-......_.Material-.. ------- <br /> No. of compartments....11�_-...----------Size.> .Y...x. ------- depth_..!y ._..-_____Capacity_*,06-'_..--- <br /> Disposal Field: Distance from nearest well. -r-'.._Distance from foundstion_.AQ.........Distance to nearest lot line_114'........ <br /> 2e` Number of lines.__..__...............�..1.....Length of each line_____./......__.__._...Width of trench... „�rf�'..:..__..__._.__... <br /> Type of filter materiaLl. r.Depth of filter mat erial../•?'..:._-.....Total length__.._.._-Q_.........._:_.__..... <br /> Seepage Pit: Distance to nearest well_./e�_r.._.Distance�ffrjom fo ndation.--/61 '._..Di tante to nearest lot line.-Ae... -... <br /> Number of pits..._/.._...__.._Lining material../.L'.,&Ae0 ...Size: Diameter__ ,�.__.....Depth_.,,7at.................... <br /> . <br /> Cesspool: Distance from nearest well.........._...Distance from foundation--------------------Lining material-.....................-_.._._. <br /> ❑ Size: Diameter._------------------- ----------Depth---------------------------------------------------Liquid Capacity.---------------------------gals. <br /> Privy: Distance from nearest well.......................................---------Distance from nearest building...__-------................._........ <br /> . <br /> p Distance to nearest lot line................ ----- <br /> Remodeling and/or repairing (describe):-..__.... ... _.' 4.." 'Qt-Le____........_.....-._...._............-.....-_.-..... �ry <br /> -'----........------'-------------------------------------------------------------_-`-----------.......----._._......./-----'--`-----------'-------------`-------------------------` ---------`-- 1' <br /> ----...`---------------.............`...-----------------.:.-----------------------------------------------'-----------'-----------'---.._.:.----.----'----------------'---'-------"--......----- <br /> ---- ------------------------------- <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules andel rreegulatiloo 's`o�f the San Joaquin Local Health District. <br /> (Signed)......... <br /> .....-.NZ7 �✓.------ -'--- �P. .....-...._................. - (O r Contractor)..... ....... <br /> By:_-------------------------------- '- _..` d72-- -----------._....-......_.......(Title).......,0� ........_........._..._. <br /> (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 1 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -° - - - - - - - - -- .............. DATE.------------ -- <br /> REVIEWED BY._.._..--- ------ -..._......... ... ... <br /> -- -- -- --- DATE-- ...........- -. _. <br /> BUILDING PERMIT ISSUED-_____....... -----.....-_-------------- ...._.--..._----------------..._ DATE ---�y----------------------- ............... <br /> Alterations and/or recommendations:-----...`.........................._....-'-------'-----------------'-----.....---...--'--...---'-----------'---'--......_-------...--"-'---...... <br /> .......................................................................................................................----------------------------------------------------------------'----.- ...-...-......... <br /> -----._.....-......----'-----..............-.................----- ............................................-'--`------"........)(- ­-- - <br /> ------ '--------------- <br /> '-------I----------._ <br /> ..........__...................................'•--•-----••-.....................----•--.._.....----................----'---------------------'�`-----`--......-----`....-.............................. <br /> FINAL INSPECTION BY:---' 111----u--I-Wl _n' ----------------..._. Date---J�1---" ---------------\------ -'------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M . Revises 1-57 F.P.CO. <br />