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OFFICE USE: <br /> 1 fll�'-;'.Cf." <br /> ---------------------------------------_---_-_________ APPLICATION FOR SANITATION PERMIT Permit No./61 _ _Q. <br /> - ------- - <br /> -- (Complete in Duplicate) <br /> This PermitEx ires 1 Year From Date Issued DDate issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and tall - 0ork a rein described. <br /> This application is made in compliance with County Ordinance No. 544. ANTF—C <br /> N_ Si D i)` / . _ c W r P'/- <br /> JOB ADDRESS ANQ L CATION_.q _ I_ ' ------� _Ikm- 1�I�F� � <br /> Owne'r's Name------------ ------POTS--6--------------------------------- ------------- ------ ------------- Phone_�T 41 <br /> Address -------- ►— ------bi h _ ( `tr <br /> ��p _ ------=----------------------------`---------- <br /> Contractor's Namem'Own" � <br /> _ rmx;rrf �� <br /> _ _ -------:----------------`----------------- <br /> Phone.. ---------- <br /> Installation will serve: Residence W Apartment House ❑ Commercial ❑ TraiIler Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __-�__ Number of bedrooms Num;;/Depth <br /> �f`bafhs"3:"'-L'ot size G_ <br /> '' R ------------------ ------ <br /> Water Supply: Public system ❑ Community sys m ❑ Private to Water Table _'- 7 ft. <br /> f <br /> Character of soil to a depth of 3 feet:- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Har pan <br /> "� <br /> Pr0evtous Appiicafion Made: (If yes,date___ _- -_.___ !_J ,No ® New Construction';-dyesNo ❑ rFHA/VA:,Yes —N-o ❑ <br /> - <br /> TYPE'OF INSTALLATION'AND SPECIFICATIONS: <br /> (No septic tank.or cesspool permitted if public..s�ewer is available within 200 feet.) c _'V,& 1 ',r� <br /> Sept' nk: Distance,from nearest well___ _ --_Distance from foundation-__J�______._Mdterial__V/V��A__TM_-_-- <br /> No. of com,artrrsents.. �y __ __ ---Liquid depth___ - -----_Ca acit 0 ; <br /> p .. Size p Y-----TO- <br /> Disposa► .field: Distance fro nearest well__�__--Distance from foundation____ ��}} j} <br /> �.�(1._-..____Distance to nearest lot lire_-- <br /> Number of lines_ <-�_____ _..___--!.-----Length of each line_____ __ _ �f <br /> ____- Width of trench_____,-4_. _-__ , <br /> Type of filter material�1_0 C ---_Depth of filter nia.tetial'�- -� __ -To}'al "lengt': 70------------------ <br /> Seepage Pit: Distance to nearest well------ ._--- Distance from foundation___________________ Distance to nearest lot line----------------- to <br /> ❑ Number of pits----------------. Lining material--------------------.Size: Diameter------------------- Depth- = `1A <br /> Cesspool: Distance from nearestrwell_________- Distance from foundation__________________Lining material--------_____.____.___________...__. <br /> El Size: Diameter__,__I _._ <br /> -- . - Depth - - Liquid Capacity ------------------ <br /> Privy: Dista-n!E_f_rom�nearest we.Il_ �._- Distance from nearest buildin '0 <br /> = 9 : ---- ------------- ------ <br /> Distance to nearest lot line____..._) I <br /> ------ ] <br /> Remodeling and/or refpalrin9`(de'scriUe}-_---_----C1 I _ - --_-- ►( - <br /> ~' �. ----------------------- <br /> : _ <br /> ---------------------------------------------------- <br /> s.. .., _ x <br /> ----------------------------•-•-----------------------------------------;----- <br /> k.ti <br /> ______________________________ _______ ------------------_�--------.---------------------------------------------------_---------------------------.,-------------------------------- <br /> ---------- .___--_ ' <br /> I hereby rtifyrf�iat I ave prepared this appiiceti no andTthat th we ork will be�rJone in accordance with San Joaquin County i <br /> ordinances, -laws, ' rules nd_regulations of the San Joaquin Local Health District. <br /> -,-(Signed] <br /> f -----------------`_ = = O - dor- on roc or <br /> BY:-----------------------------------•---------•= ------ -------- <br /> ------------------------------------------------- Title <br /> (Plot plan,.showing,size of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> p C <br /> APPLICATION ACCEPTED BY---�ii-l--°p-'.----- ----------------------- ----------------- -------------- DATE--------�_'.��'_°. .---- <br /> --- ------ <br /> REVIEWED BY-------------------------------------------- --- ------------ ----------- -- - ----. DATE------------------------- <br /> - ------------------------------ - <br /> BUILDI.NG PERMIT.ISSUED �,_._------------------......= ----------------- .....- ----- <br /> __ --._.._...-------- <br /> - <br /> A{#erations and or recommendations:_ <br /> ----------------------------------------------------- — - �- ------Y — ----«» - . <br /> ^� , -------------------- <br /> ------------------- <br /> -•----------•-------------------------- - <br /> - -------- ----- --- <br /> ' :' ' =z= -------------------- --------- <br /> FINAL INSP - L <br /> - Data- - Q_ . <br /> ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 3M 3-'63 F.P.Cq, <br /> { <br /> k� Y <br />