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FOR OFFICE USE: r i <br /> .............. <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> -• ---• ......................-•.................. <br /> 1._7��__:.__ <br /> ................... ......--...... .--•• ' (Complete in Duplicate) <br /> ......_.__: Ion <br /> This Permit Expies 1 Year From Date Issued Date Issued+ Application is hereby made to-the 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. � �; ZI Z _ 1910—// <br /> a P7-2 �.S'• Cal c-Nro .us'��j? �'� m�iill 7/ '` 7i -rte-✓ ._.__._... J7 <br /> JOB ADDRESS AND LOCATION--------------e•----- -4 -f'•---- ...----- <br /> Ga.rr Phone.............................. ..... <br /> Owner's Name..........max---..-------••----- x. -lr�A1 ..... �' <br /> Address.--_•-•----••---•-- .>? = j. ....--••- � - , ......................................... <br /> Contractor's Name...........................[I .......... <br /> ._. Phone.................................... <br /> Installation will serve: Residence Ap irent House ❑ Commercial ❑ Trailer 'Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __..�._'I Number of bedrooms ...'Number of baths -4_. Lot'size __._ .. _.'---•-----•-••--------•--•••-----•- <br /> Water Supply: Public system ❑ Community system ❑ Privatel, Depth to Water Table ..... ft. <br /> Character of soil to a depth of 3 foot: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If ye ,date ......... __.) No� New Construction: Yes a No , FHA/VA: Ye ❑ No� <br /> Il. <br /> TYPE'OF INSTALLATION ANDTSPECIFICATIONS Orf 11 <br /> ''' "'T �""�"``'* a`- �"'""""'•"� "" <br /> (No septic tank or cesspool permitted if public sewer is available within:200 feet.)- - r t <br /> pl' 7 o"a(�---...Mater's!_ :-_.------- <br /> Se ti Tank- Distance from .nearest well.- 6w fro foundation....._._._ ._ N <br /> No. of compa;lments..___.R.... __._....size....7 �.-x_ __.Liquid depth........... .._. Ca aci <br /> Disposal Fie4d: Distance from nearest well..G-t?.......Distance from foundation,- p- Distance to nearest lot line_.. <br /> i <br /> '+' L� . Width of trench--- � . <br /> Number of lines._..i .___................ .Length of each line.___..._.._./ __. __ <br /> Type of filter material / .......Depth of filter materl ...._..TOtal length.._......._/�.T.2.._._...c_._...__.. <br /> Seepage Pit: Distance to nearest well......................Distance from foundation___-_______-------._.Distance to nearest lot line.................. <br /> Number of pit ......................Lining material---------- ------------Size: Diameter..................--.__Depth....................... -----• p <br /> Cesspool: Distance from: nearest well.................Distance from foundation___...... ..__.___.Lining material...................................... <br /> Size: Diameter__.-_..... .................. -----.Depth-------------------- ----------- ....---------..Liquicl Capacity­-----------­---------_gals. S <br /> i-ow <br /> Privy: Distance from'nearest well.._.................._.-._______.____.-.•-_-.=.-•Distance.from,nearest�6uilciing_: <br /> ❑ Distance to nearest,lot line--- -------------- -----------• '.. .............................................------- ................... .................. -----• r <br /> M <br /> Remodeling and/or repairing (del'Cribe}:-- -.Sct.c�--...._. h'.•. <br /> rte <br /> 1 t r ---------- <br /> ..mac <br /> I <br /> I� <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinan\s, S�taatee flaws, and rules ind regulations of the San Joaquin Local Health District. <br /> (Signed —' .1.: J? - :/�•--_- ". ...•^/ __._.---------- ...................ii- <br /> By: <br /> -------•...................••-•- <br /> ..................-................-----------------...{ /or Contracto <br /> By:................................ ... .. ----­--------­ ----- rifle--------•-•- .._........... ....... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY.._ ....................._......_........-------•------....----------------------•------------ DATE..---•-- - <br /> REVIEWED BY­------------------ -------.IM!............ ----------- .................... .. .•••---.---.....I......... DATE---------- �.....,. <br /> 7 <br /> BUILDING PERMIT ISSUED------- '--------- •------------- - /, -v� -•--•-----•--•------ DATE. - / •- <br /> IAlterations and or recam end ions:.................. _. _.: .. •............--•-------- -----•--_--_----•------ <br /> .__��.'!'..� ?! �fc � � _ ....12t��-mer..... _-.1�._--"• .,, s!ua7..... �4�...,c�.:- <br /> I' <br /> --.-__.....-•-•-•........:•!-....._.-.................. -......---••-....--- - ............................................•-- <br /> .. ................ <br /> ....................................................... -............... .--- .-----•---------•---••-.............................................................. <br /> FINAL INSPECTION BY:...---..�..:_...:-_:W.- ­ ---------- Date....- -J �'�' ._....._ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasel►on Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stacklon,California Lodi,California 1.4 Manteca,California Tracy,California <br /> CS 9 REVISED B-S9 3M 3-'63 r.P.COJJ• <br />