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�e., �-�,�.s���--.-�.<-,:,- � APPLICATION FOR SANITATION PERMIT Permit No. __/._�.b... <br /> ----------- . ................. (Complete in Duplicate) <br /> Date Issued <br /> ----------- . This Permit Expires 1 Year From 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. 1 <br /> JOB ADDRESS AND LOCATION.....! . ` 0.......N.UWMT o-------- ..............-............................................... --••------- <br /> i <br /> Owner's NameYllti .A_Q_k-,,a......l�:.v_.a.I er .............................. Phone.._1. .0. `�-00.1...._.. <br /> - ...._............. ....._.. <br /> Address..............{__5.f�_r.*.t�r...)........................................................... --......---- ----------------------•-----..--...------------- <br /> _-------------- <br /> Contractor's Name----------17.......l.3....... •-----4-_S.o.-tt... r"}.................................. .... ..... <br /> Installation will serve: Residence ff Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..l----- Number of bedrooms .-� Number of baths ----I... Lot size ....--f ........................... <br /> Water Supply: Public system ❑ Community system ❑ Private a Depth To Water Table .6e. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam Q'.Clay,❑__Adobe []� Hardpan ❑ <br /> Previous Application Made: (If yes,dote... ---.---------) No K& New Construction: Yes&a' No.❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a <br /> Distance from nea6 . �iMaterial._. <br /> R . ..............Septic Tank: No. of compartments....__...Z�______._--- -T. Li uid dePth z ...._Capacity---- .� <br /> , <br /> 67 ; Distanc <br /> _..._ e from four►dation_._._: n____._.Distance to nearest lot line___r.2 <br /> Disposal Field: Distance from nearest well _ CG?..... <br /> �j Number of lines----------------/..... ......-----Length of each line------------ .-Width of trench........ : .`.......-..----.---- <br /> Type of filter material.... �..61<.....Depth of filter material------ ..........Total length.................. ............ <br /> • f <br /> Seepage Pit: Distance to nearest well----- A7e.........Distance from foundation_-_- n_........Distance to nearest lot line.... J......... <br /> Number of pits........!--------- Lining Size: Diameter____33.._.. ... Depth......_.....9-i-r............. <br /> Cesspool: Distance from nearest well............. ...Distance from foundation.._... . .........-Lining material.........._...............-......... <br /> ❑ Size: Diameter-.----------- ...-- ..------- Depth t............................ ----- _..Liquid Capacity...--_------- ....gals. <br /> t <br /> Privy: Distance from nearest well ..............Distance from nearest building................____.......... .......... <br /> ❑ Distance to nearest lot line... ...-•-•--•.....---...... -----------__.._.-.-.._._.................................... <br /> ... <br /> :_...... <br /> Remodeling and/or repairing (describe):.... 4,0U4-by <br /> 'J'_7<--- 7�?. ..._._l r /IT c.L�----------• <br /> ....... .....................................• ------ ---- ----------------------------------------------............................................. <br /> I <br /> I hereby certify that I have prepared this application and that the'work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joequin Local Health District. <br /> /� c7�. - --------------------- ---- ----------------( ner and/or Contractor) <br /> (Signed) ut'J � ��-'----/_�'-C��..!1,.i,a.�. .._. D-r�..�......:............ <br /> r+le. <br /> C -- ----C�.. .�c - _ . <br /> (Plot plan, showing size of lot, Iota on of system in relation to wells, buildings, etc., can be placed on reverse side). .. <br /> , r r <br /> FOR DEPARTMENT USE ONLY r <br /> APPLICATION ACCEPTED BY... -X� ••-•--------------------- DATE--- �. ------- <br /> REVIEWEDBY.................. .........---- i.... :.. ._.... ---------- DATE_....... ....... .....-..............---_------ <br /> BUILDING PERMIT ISSUED ••--•- ----------- DATE <br /> Alfer ns d/or ........:....................... <br /> ---------------------•-.._.�.... <br /> ---------------- ------- ...............--- -------------. .........................------- ----------------------------. ...- ------ ----.-._. ------- ----•-------•--- ---------- <br /> l 1. <br /> -'........................•......................................--................3•............... ....----..:----"-;----------' ..........................----- ..-� .........-------........ ...................----.-- <br /> E <br /> FINAL INSPECTION . Y. ._.. T <br /> Dote.. . ".. ... -------------- <br /> SAN AQU1N OCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 DEVISED 8-59 2M 5-62 ATLAS <br />