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F01?QFFAUSE/ <br /> /1.9 7 <br /> _A --------------- ------ <br /> ------ ------- ----------------- --- -----------I-- ---- APPLICATION FOR SANITATION PERMIT Permit No. .13q <br /> -- <br /> ....................... <br /> -------------- --------------------I--------------------- (Complete in Duplicate) <br /> �k- .� Date Issued <br /> ----------- <br /> I------------­---- ----- -------------------- This Permit- 'I Year From Date'llssue'cl'77 <br /> Permit-.Ex -7 <br /> Appli��fion is hereby made to the San Joaquin Local Health District for a permit to construct and all the work herein/des ibed. <br /> This application is made in compliance with County Ordinance No. 549. 1 <br /> JOB ADDRESS AND LOCA <br /> ------ ----- <br /> ---------- <br /> Owner's Name.---- <br /> -------------------------------- ---------------------------M VI-1 <br /> Address---------------- I <br /> ---- -- ---- --------------------------------------------------------� 1 0 <br /> ---------------- ----------------------........ ............. <br /> Contractor's Na e_---_ <br /> ----------------------------------------- ---------------- Phone--------__-- <br /> ------------------------------ <br /> - ----------------------- <br /> Installation will serve: '.Residence Z20"'Arpartment.Houseio Commercial F] TrailerlCourt E] Motel [I Other 1-1 <br /> Number of ii,ing-, units: Number of bedroom's �--- Number of % Lot size -----------------_------- <br /> r - .1...- I . 40 <br /> Wafer Supply: Public system Community syst;m­b- _Pr_iv`a7te-` <br /> Ug­'Depth to Water TO'ble -7-4C?ft-' <br /> Character of soil to a depth of 3 feet: Sand E]' Gravel E] Sandy Loan Ej , Clay'Loam E] Clay [I Adobe 0_11a`rdpan El <br /> Previous Application Made- (If yes,da;e---------- o <br /> N <br /> No New Construction Yes ZKno 0 FHA/VA; Yes g;/ o E] <br /> TYPE OF INSTALLATION AND SPEC iFICATIONS: <br /> (No septic tank or cesspool permiffed-if public sewer is available aiiiable wi4hiln'!_200 fe6f.) <br /> ,gamVv. <br /> e Ar , M f <br /> Septic Tank- Distance from'nearest _.:..._Di�taxnc - from foundafi,on ' ,e- __r----- er I-- -------- --- -- ----------- <br /> No. of compartments_----_- 7,49 Liquid'-de'p�th _ ----___-,Capacity___ <br /> �. ,Di�fan �afion_/P Distance to nearest I t lin <br /> Disposal Field: Distance from nearest well Distance from found e <br /> -%5 <br /> Number of lines.__Z___._.,------- 'Length of each line__ _j------ <br /> ____.Widfh ,of fir6rich---- <br /> Type of filter.material. Dept-h of filter, material---Xr_ gth.--�� <br /> -Total len <br /> Seepagp,Pit: Distance to nearest"ZIC f f da ton­xo--------Distance f6 nearest lot line_.k._-f__ <br /> T, u ------ - <br /> - ------------ n -Siie: a ete <br /> Ile Number Z Lini'g r�aferial__��_�w .-Di -------4.Depth- - ----------- <br /> Cesspool- Distance from nearest well---------- ------Distance'-from foundation: <br /> -----------------..Lining material----- -------------------❑ ------------ <br /> Size: Diameter:-.' - ----------- <br /> Depth -------------- <br /> ----------------- -----'_n__nLiquid Capacity---------------------------gals. <br /> 11Privy::: Distance from-'nearest well________________- ____ -------------------:_ _`_.Djsfance,from:earest building_____---__________---- _----•---_--. <br /> ❑ 'Distance <br /> ----- <br /> 'Distance- to - <br /> e <br /> noarest'lof'lih -------------------------� <br /> ---------- ------------------- <br /> Remodeling and/or repairing <br /> I ---+' - .. - ---------------------------------------- <br /> ----------------------- <br /> ---------------------------- ------------------- ----------- -------- ---------------- ----------------------------- <br /> ------------------------ <br /> ----------------------------- --------------------------------------------------------- -------------------------- ------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------I--------------------------- -----------------------------------------'-----------•-••------- ----------------------------- <br /> I certify that I have'p�epac'ed fhisapplicafi�n'and that the 1 'work will-6e'dbhe in accordance with San Joaquin County <br /> ordinances, State laws d les and'-riquiations of the'San Joaquin Local Health.D46frici. <br /> ------- -- -- <br /> By:. <br /> - ---- ---------- --- <br /> (Signed)----------- ---wi, ---------------------------- <br /> '16 ---- ------ Confracforl <br /> By:------------- <br /> ------------------------------------------------------- -----------­-----------------(Title)_ <br /> ---------------------- <br /> (Plot -------- <br /> plan, showing size of lot, location of syst n relation to wells, buildings. c., can placed on reverse side). <br /> FOR.DEPARTMEN_LUSE-ONLY—' <br /> ------ -------------------------------------------- DAT <br /> APPLICATION ACCEPTED BY� - .. ! <br /> REVIEWEDBY-------------F-------------------:'.1�_(/-------------------------------------------------------------t-----I-------------...... DATE <br /> BUILDING PERMIT ISSUED------------ I . L r <br /> 1:T---------------------------- ------ ------*­--------------------------------------- DXTE--------------_-------- <br /> Alterations and/or recommendations___________------------------------ <br /> ---------------------------------------------------:--------------------------------------------------- <br /> -------------------------------I---------- -------I---------------------------------------------------------------------------_%----- ----------------------------- ---------------------- ------- <br /> n relation to ef <br /> --------------------------------------------- _1-------- ----- , I I -------------------- <br /> ---------------- ------- ------- ------------- -----------------------------------• -------------------- --------------------------------­_­---------- <br /> ---------------- <br /> ------------------------------------------------------------------------------------------------------------- -------------------------------- -------------_ <br /> ------------------­­-------------- <br /> A. <br /> ------------- ----------------------------­---------------------- --------------------------------------------------------------------------------- ----------------------------------------- <br /> 40 1 eN <br /> AL INS <br /> 4 INAL INSPECTION BY... ----------- Date--- <br /> ------------ -------I---------------------- V...... --------------------- ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1.110 South A. <br /> erican Street4l,�,4,�,, S3_6k`Wes'10.k Street 1,�4 Sycamore Weet <br /> 1 205 West 91h Street <br /> "N V, 4 <br /> Stockton,California Lodi,California N"'IM-kinteca,Co0orrila <br /> ES-9 REVIBLD 9-59 F.P.CO.ZM 6.60 'It Yr-colifornia <br />