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- ­FORrtOFFICE USE: <br /> MV171 <br /> 4.-r ---------- _ APPLICATiO`N POR SANITATION PERMIT Permit No. _..�__----------- -- <br /> --- ( 3 :lS (Complete in Duplicate) <br /> `V ;ff' Date Issued <br /> .__..__._.-_ This Permit Expires 1 Year or m Date Issued <br /> V- -- - - From <br /> Application is hereby made to the San Joaquin Local Health District f a permit to construct and instal4 the work herein described.Ii <br /> This application is made in compliance with County Ordinance No. 549. IAX <br /> JOB ADDRESS AND LOCATION.... ......51 ------ ------`-----------------~--- •-- I <br /> Owner's Name---------------- ------- ------------------------------------------------------------ Phone <br /> Address----------------------------- -1C_1 --- --------- .,c 1.. -------------------------------•----------------•-------------------- ---- --------- <br /> --- <br /> ._.. <br /> Contractor's Name---------- -'--. = ---------;:_7-ham-s _----•----------------------------------- Phone.. �6re`rU_��_!! <br /> Installation will serve: Residence ❑"Apartment House ❑ Commercial ®-Trailer Court ❑ Motel ❑ Other ❑ IM <br /> Number of living.units:.,_,f,_, Nu ber"of bedrooms _ __ Number.of baths.__,_ Lot size ___lQ _ -�a-_-----_--_______----___'i <br /> Water Supply: Public,system Community system ❑ Private ❑ Depth to Water Table -------- ft. ! <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Ca_-Clay ❑ Adobe ❑ Hardpan ❑� <br /> Previous Application Made: (It yes,date._.___--..-_.-- -) No © New Construcfion: Yes ❑ No E3--f-KA/VA: Yes ❑ No ❑M <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance'a,from' nearesr�welL________________Distance from foundation_____.___________.Material------------------------------------------------- <br /> _ <br /> No' of coni artments------ ------Size------------------ -------------Liquid de th.--------------- -------- <br /> -- Capacity ------------------ <br /> Disposal Field: Ditan• �fom nearest wall_______ ____Distnce from foundation--- Q____._.Distance to nearest lot linef�____ <br /> Numbewy� lines____-_ ----------- Length of each line �� ---------------Width.. <br /> ,EI <br /> oftrench f- f --------------'I {� . <br /> Type of filter material___ '��/t_bepth of filter material____AIR,----------- _ , � _ � <br /> ._Total.' Length___.__ __ __ __- -__-__ ___ <br /> See E l <br /> page Pit: Distance to nearest well----_ �--_--Distance fro ation__ __._-.Distance.to nearest lot iine_Aa-_-__.._' <br /> -Linin mater's _____ / ize: Diameter"__ ✓. .`....___De,th ,. ...��_____-- <br /> ®�� •-�-f�,umber of pits------� g .. . P ..... <br /> Distance,fl•om nearest well-----------------Distance r m oundation.-------------------Lining material--------------------------------------- <br /> Size: Diarrieter____--- `-----------------------De th <br /> Li uid Ca aci# als. <br /> rPrivy: Distance from nearest-well ___--__-.____________________________---------Distance-from-nen rest building.._._..._____________.____--____..___..._I! <br /> Distanceto nearest lot line--------------------- ----------- ------------------------------------ -------------- ----------------------- <br /> �s <br /> Remodeling and/or repairing <br /> de)=----- ------- �`ae ----- <br /> 4 t� --- <br /> - <br /> t A - <br /> ------------------------ --------------=------------------------------------------`---------------------------------------------------------------------------------------------------------------------------------------- <br /> -._ <br /> --------------------------- IjlI <br /> ]i <br /> ='----------------------------------- ---------------- <br /> ------------------------------------------------------------------------------------------- - <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County's <br /> ordinances, State Iw ! rules,and"regulations of the-San Joaquin Local Health District, it <br /> (Sign' ------------------ <br /> ad)- � 1 I <br /> " f 1 / �.--.- - .�. can/ernd/or Contractor)!, <br /> BY� s 1�4 -------------------------- ' `'� (Title) _ - i s <br /> II <br /> (Plot plan, showing sizeW lot, location o/ f system in relation to wells, buildings, etc can be placed on reverse side). I� <br /> FOR DEPARTMENT USE ONLY <br /> • APPLICATION ACCEPTED BY------------------------------------------- _________________ DATE-------- _9_ GS <br /> REVIEWEDBY---------------------------------- --------------------------------------------------------------------------- DATE---------- " <br /> BUILDING PERMIT <br /> 1ISSb <br /> ED-�---�----�--------------------------------------------------------------------------------------------- DATE--------------------- - -- <br /> II <br /> Alterationa 6/oreccommendations: ------------------------------------------------------------------------------------------------------------------- -------------- --------- <br /> -------------- . _- - --------------------- ---------------------------------------------.------------------------------------------------- 4 <br /> --- ------------------ <br /> ` f' ► �' s <br /> . _ - - ------ II <br /> -------------- ------------------ --- ---`-----;;:;-------------------------------------- -------------------------------- ------ --------------I �- <br /> -------- - ------- <br /> ooc' <br /> FINAL INSPECTION BY:-----------r.'Z.t-------- --------- ------------- Date----------- - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT �I <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I` <br /> Stockton,California Lodi,California Manteca,California Tracy,California 5 <br /> II <br /> I� <br /> I� <br /> 1. F <br />