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_,,FQR OFFICE USE: <br /> ---------------------- -------- ----------------------- <br /> APPLICATION FOR 'SANITATION PERMIT Permit No. <br /> -------------------- ------------ - ----- ----- (Complete in Duplicate) <br /> Date Issued <br /> This Permit Expires I Year From Date IsLued <br /> Ik <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 aF)plicati8nfis.r�ade.in�com*plia—nce with County Ordinance No. 549. CA L ON <br /> 6 . C19 p <br /> JOB ADDRESS AND L CATION__ <br /> ---------- <br /> TEF------ -------- <br /> _N I F I ---- -------------- ----- <br /> _0r1r i.� - -----------_-- <br /> R q <br /> Owner's Name___ --------A -------- --------------- -------------------------- -------- Phone--------------------- <br /> 1� -L- a <br /> 3 <br /> Address ----- --- ---------- <br /> ----A-Yt--------------- a!--- -------------- ------------------------------------- ........ <br /> -------------------------------------- Phone----------------------------------- <br /> Contractor's. Name_-_0A1<Dt9 ------- <br /> Installation will serve: Residencei �Apartment'House-o Commercial El Trailer Court E];,,MGteI'0 Other El <br /> -size --- <br /> Number of living unitsIff m, 3 <br /> -------- Number of bathv Lot ---------------------- <br /> ..00" <br /> Water Supply: Public system syst&n� El Private.ETI*%[DpTt.h-to-Watdr Table/P10- ft. <br /> Public! *� CC . .. _00-;Ow' 1_*�. <br /> Character of soil to a deptho—f 3 f..a: Sand C] Gravel E] Sandy Lbarfi'[3 Clay Loam e Clay E] Adobe L] Hardpan <br /> I _,t I el <br /> Prey; s,d6te-------------------I N New Construction: Yes UN, E].._FHA/VA: Yesi,e No E] <br /> Previous Application Made: (If.y <br /> TYPE OF INSTALLATION AND SPECIFICATION_S. <br /> f <br /> -(No septic tank or cesspool perm itted-ifrPU61lic sewer is available within 200 feet.) E7 F=tq <br /> 09 <br /> Septic Tank: Distance fil%ominearest well--! ------Distance from foundation____Z �-------Material- R_-R_ _ np------------i- <br /> gt-_� --No. of cot'Pp`ai*4,n1s- ------_Z_ SillAII -XIAPA-151-Liquid dep.th- ....Capacity... ------- <br /> A I - -X"A <br /> Disposal Field; Distance frominearest well-_-_.%5_O--_Distance from foundation.._1&0--------Distance to nearest lot <br /> Number of lines--------0-----------------------Length of each <br /> Type of filter material-PE-70-C�K----Depth of filter m4Teria12__J6'_"___ -Total lengfh-------- ------------- <br /> fTor- rest I E <br /> Seepage Pit: Distance t9,rnearpst_yeff—__/_tZ7tt---- Is'ance from founds istance fo_nP rest -------- <br /> --me 4=_4 !7 f <br /> -- - ----- ------- n M pf�... ----------------------- <br /> 0i pitf*�_ _ �Ei �ng afaf, Dia <br /> met <br /> Cesspool.,,-jh%T well-----------------Distanc from foundation-----/_------ ---__-Lin ng.mafp'i'�, ------ <br /> 1 41�apac!ify----------------- ._r___gajls. <br /> ❑ Size: Diam!fer--- ------------------------------------Depth__,---t---------I--------W4V--------- - qk <br /> —47,A <br /> est we -t bull ingo -------- <br /> Privy: Distance Arn r1ear 11------------------------------- ---------Diisf'ancef�om'neares <br /> FjDistance to nearest ]of line----------- ----------------- ------------I----------------------------------I ----------------------I---------------------------------------- <br /> (OQ <br /> Remodeling and/or repairinq (d j3_F__-N'T VY) -------- <br /> _6_p rn <br /> AN V <br /> ----------- - ------- 40-4m- -07S--------N-0--------H-1�- -P------H-kl <br /> ­4�4 -K-It ------I------- CP <br /> ---------- ------- ---- <br /> -------- ------ - - ------------ L&V <br /> lk t _h <br /> ------- ----------- --------INY= -----of .....e-------------k---------------- <br /> --------------------------------------------------------------------------- <br /> I hereby certify that I have Prepared this a h <br /> .pplication-and'tha+ the ;ork7.1I'9;e ...Man.. with San Joaquin County <br /> ordinances, State laws,dan rules and0F%:§uIa+ioA-rof-,th-e S�ajn' Joaquin Loc�al Health District. <br /> 4 <br /> Signed):=--- �4 4;2�j -Contract <br /> 5rnqr_5C J . _cArl <br /> (0 ' d/oj <br /> By:------�/,,am. 4-e--------------- ----------------------------------------------------------------ATitle)--- <br /> {Plot plan, showing Size of location of system'in relation to wells, buildings, etc., can be placed on reverse side}. <br /> ,Y� i location <br /> .I <br /> V FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By---- TiR.-O--------------------------------------------------------------------- DATE---____--9------j_r------------ ------------------ <br /> REVIEWEDBY--------------------------------------- -- ---------------- DATE---------------------------------------------�t------------- <br /> BU I ILDING,PERM I-T—ISSUED------.--.--- --------- -------- <br /> ---V(i ----------------------- <br /> A <br /> --------------------------------------- ----------------- ----------- ----- - -------------------------------------------------- <br /> ------ ------------------ ---- -------------------------------------------- <br /> --------------------------------- -------------------- ------------------------------------------ --------------------------------------------------------------- - ---------------------------------------------------- <br /> ---------------- --------------- -- ------------ ------- ----- ------ ------m_-—------------------NA----------------------------------------------------------- <br /> .4 <br /> ----- ---- ------- -------- - --------- - ---- ------ .... .. ----- - - -------------- ------------------------------- - --------------------------------------------------------- <br /> .Date-- -- --- ------------------------------------------------------- <br /> FINAL INSPECTIO - -- --- ------------- - --- -- -- �2--0 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 1 . ES 9 REVISED 5-59 3M 3-*63 F.P.120. <br />