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00 <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />This Permit Expires I Year From Date Issued <br />Permit No. <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 L,(?CATION ---- Joe ---------- <br />Owner's Nam, e <br />Address_________ -------------------------------- ---------- --------------- ------------ --------- -------- Phone ------------------------------------ <br />1� --------- ... --- ------------- ----------- ---------- k -------------------------------- I --------- ------------------------------------ .......... ------------ <br />- - - - - - - - - - - - - 7 - - - - - - - - - - - - - - - - - - - - - - - - ----------------- ----------------- <br />Contractor's Name---- Phone, <br />Installationwill serve: Residence Apartment House E] Commercial Trailer Court E] Motel E] Other E] <br />Number of living units! __/--- Number of bedrooms -,$-- Number of baths Lot size ---------------------- <br />Wafer Supply: Public -system El Community system [:] Private 0y0"15epfh to Wafer Table �a_ ft. <br />Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam 0 day Loam UR—Clay El Adobe El Hardpan 0 <br />Previous Application Made: Yes E] No � New Construction: Yes [�No ❑ FHA/VA: Yes 9j" No El <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200'feet.) <br />>a Distance from nearest w:el ----- Distance from foundatio <br />Septic _J. 4-11- - -7 n_ --le'_ -------- MaferiaJ ---- ----------- <br />X5 _,oY%0Xquid depth__"`6 - - ---------- Capacity- Z-AP4*9 ----- <br />gr No. of comparim - -------- Size -47.. i� <br />Disposa!field: Distance from nearest Distance from. foundation... .......... Distance to nearest lot line <br />Le Number of 29 <br />lines ------ 9-e ------ -- Length of each line______!_ r .. .___._____'.Width of trench .__.• 01 44?� ------------------ <br />Type of filter material__ OaDepth of filter material ----- JJY**'-'.-Total length ------ Ito4*- <br />A&Al" <br />Distance to nearest ell-_ <br />ram ---- 4K __Distance to nearest lot ]in,-- -- ------- <br />Seepag�,Sif: s .10P -----____Distance f f 0;udaf ion A& - j -_ 44 69 41 -le <br />Number of pits--- _Size: Diame'ter__ ---------- Depth ---- P&-lof -------------------- <br />RK - . __ . _7 <br />_X ----------- Lining maferiaI_X_ve,0_' <br />Cesspool: Distance from nearest well -------------- ..-Distance from foundation.,__,,x,�_ <br />Lining material material_ <br />_______ -___________.___________._ <br />Size: Diameter -------------------------------------- Depth ------------ ------------ ------------------- _Licluicl Capacity --------------------------_ gals. <br />Privy: Distance from nearest well -------------------------- ---------------------- Distqnc e from nearest building_____.-________________________.___--_--. <br />❑ <br />uilding----------------------------------------- <br />EIDistance to nearest lot line.-. --------------------------------------------------------------------- ---------------------------------------------------------------------- <br />WZ-M --------------------- <br />Remodeling and/or repai6ntj'(descri­btF)0 ... !t ;rlie� <br />---------------------------- <br />-- <br />-- -------- 1 - . <br />47 74" Y <br />------ ?--/ ------ <br />ly- <br />------------- 'V -- ---- -- ��O- _e ------------- ------------------------------------------------------ ------------------------------------------------ <br />........ mi <br />I hereby certify that I have preparedihis application and that the work will be­done'in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />-------------------------------- <br />(Signed) ------------- xi�� ----- 1XI - --- ---------------------- --- -- ---- --------------------- Contractor) <br />--------------------------- --- — ----- -----------------------(Tine)--- - <br />- <br />By - <br />(Plot plan, showing size of lot, location stem in relation to wells, buildings, etc., can be placed on reverse side). <br />APPLICATION ACCEPTED 13Y_e_r�'�___ -------- - �_ ------------------------- <br />REVIEWEDBY -------------------------------------------------------------- ---- ------ <br />0"11 ISSUEDDrD"IISSUED <br />--------- DATE---------Y".--,-5r--- _ -------------- <br />DATE------------ ----------------------------------------------- <br />---- <br />----------------------------------------------------------- ------------------------------------ ---- DATE-------------------------------- - - --------- - <br />Alterationsand/or recommendations------------- _ ----------------------------------------------------------------------------------- ------------------------------------------------ <br />------------ W -------- ------------------------------------------------ <br />/4-/ ---------- <br />P- ---- ------- <br />--- - ----------- Z r ------------------------------ ------------------------ -------------- --------------------------------------------------------------------- <br />-------- 0 __ ----------- ---------- -------- <br />-- ---------------------- <br />-------------------------------------------------------- --------------- ---------------------------------- I ------------------ -- ----------------------------------------------- --------- - <br />------------ ---------------------------------- <br />FINAL INSPECTION BY:. ----------- --- --------------------------Date- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manteca,, California Tracy, California <br />ES -9-2M Rev;sed 6-'59 F-P.Co. <br />