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FGR OFFICE USE: <br /> r <br /> .....».....«......................................... <br /> ..........................._........... APPLICATION FOR SANITATION PERMIT Permit No. ...................... <br /> ..................................I................. (Complete in Duplicate) <br /> Date Issued <br /> This Permit Expires Z Year From Date Issued <br /> application is hereby mane 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 /> i <br /> Vq- <br /> Jos ADORI:ss A D Lc�CATION�/, � .. .•.. .__. �...... _ . > ............... > <br /> Owner's -= .. - .......... ....................... ............... Phone............................... <br /> ...._ <br /> Address---...--.__`�,.�?L_��_...-----L _ _.._.__ ?.i? .«,. .. PJ1l r. ," �- � ...... .... ...... ................... <br /> Contractor's Name-MAN.7-1�E.C.6.•...,e��. T.�mow.._...,` ! ....« ................... Phone................................... <br /> Installation will serve: Residence [Apartment House'❑ Commercial ❑ Trailer, Court ❑ Motel ❑ Other ❑ + <br /> Number art living units: _ -._._ Number of bedroom .'7L -Number of bas13. tsiza ......I" ................. <br /> ._°. . r <br /> Water Supply: Public system ❑ Community system ❑ Private (Depth TO Water Table ,�NX ft. <br /> If <br /> Character of soil to a depth da feet: Sand Gravel [] San y Loam &KIClay Loam 1711 Clay❑ Adobe[3Hardpan ❑ <br /> Previous Application Made: ll yes,date........ ....... <br /> No Now Construction: Yes L;' No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INVALLATION AND §kCI66AB6NS: .. <br /> (No septic tank or cesspool permitted if public sewer is availablew�t�in 200 foot.) <br /> Septic Tank: Distance from nearest wolf.................Distance from foundation....................Material.......__. ................. <br /> .�.-..._._.--_.... <br /> K15Y7>J& No. of co apartments....._.....«.............Size.............j ........,__-Liquid depth................._.......Capacity_.----.-............... <br /> Disposal 'Field: Distancv.from nearest well <br /> ..`....,..`.....# istance-f�zn1f6u:nddti66.................,-..Distance to nearest lot line................. � <br /> i N& Number�.off lines-_._...._.. Length of each line.........I....................Width of trench...._.............................. <br /> Type of Ater material..............-..........bept h.of filter material.-...................Totallength,..,......._............................. —� <br /> Seepage Pit: Distance talnearest well_.....�.s�r......_tistance from foundation'........ D}stanc fig nearest lot line....'.. � <br /> Number/ pits.......... ..........Lining rrat riai___ � .....5iza: Diameter_ ._. p <br /> Cesspool: Distance m nearest wel.,erM._.__... Disfiance from found ti ....................Lining material............. <br /> _...._.» ..»...» <br /> Size: Mani ter.................... ..... ....... Depth........ .._ ...................Liquid Capacity..__...._.....»_:.....__..gals. <br /> MW I <br /> Privy: Distancerom nearest well,....._. _ -D'stanc�e from nearest building....«...................__............ <br /> ❑ ... tit <br /> Distance nearest lot line_..._.. _.-._ __ ...ri........------.......»..._«...__._.........._._._.._........................_...... <br /> . <br /> Remodeling and/or repairing describe) _«_ <br /> ._...J.J . Ip4r. ...... tld. . _.i. 1. j .. -f,14._,........ <br /> ................«-.---.....»__.....__._...._.... _. <br /> »__. ...................... ! �• -- J •- -- ` _-._._. . - ...A .._..................`� .��..._.._._..»..__»_»....__.. <br /> ...........«_........./ . ..........I...... ........ ......... w ry..... ........... . ----. ........•......._.« » •--•-....................«.,...... <br /> 1 hereby,+certify that I have epar d this a i"p'lica#ion and that the wor>�igill de done in accordance wit3r San jloaquin County <br /> ordinances, State laws; a x les In r ulatiyori of the San Joaquin Local HealtA District. <br /> _ . caner and/or Contractor) <br /> _. <br /> By:........-........................... ...... ........ - ,.�.- ............__.._._. (Title}.._....._....._. ...... _ <br /> {Plot plan, showing size of lot, location of system elation to walk, buildings, o�tc., can be placed on reverse side). <br /> 'FflR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... . r.t/ ............._»..._....__._.............. . DATE.... <br /> REVIEWEDBY........ ............_...... ...............................«......._._ DATE..................._..«._«-.. _. <br /> BUILDING-PERT-iS�SUEfls �. . p;4T <br /> -Mt «« <br /> -...t«�v._>...... i..:H'u:....�._,.. ... ......,.w.+�....._..s.w..... r.. v. ..w_..._... .v. .. •.s Lia•_. ... .. r..`Li.�. :�lr..:.:•S-Lr:3,• <br /> Alteration% and/or recommende73ons:.....................>p..M1�t........._. �.f .C. •lW___.."1._....._..... ......................................................... <br /> .___...... <br /> «.«_. ►:art Irr+� <br /> ...... ................................. `-` ........_................_ ......._....._........ . ...._.............'�........._.�................««............................._........------ <br /> .................................A. ........ ........................ ............................ ...... ............. ---- ............................. <br /> .._.•.r. ....._...................................._................,.........._..__........--•..._...........-_._....._. <br /> �INAt�`tNSP........... �........ .. ...- -.J���?..._.......»Date....•`..��--.�-��/ 2._.,..,,_,,............... <br /> .............« <br /> � . . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South luneriean.,,'�S,t�raet 300 Wort Oak Srnet 124 Syammom Street 205 West 9th Street <br /> Stockton,Callforrlki Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />