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t -UK U1 ­J -Kt USE: ...... <br />--------------- --- <br />jT <br />--------------- - ----------- ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No . ........................ <br />---------------------=----- ---------------------------- (Complete in Duplicate) <br />---------------------------- ------------- --------------- - ii 'i, --Q. I <br />This Permit'ExDires I Year From Date1ssued Date lssu'ed __71 - - - --- ------- <br />Applica�tion is hereby made. to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br />This application is made in compliance with County Ordinance so. 549. 1 <br />t <br />JOB ADDRESS AND LPCATION ----------- <br />----------- .. ------------------ ....... - ---- -- <br />--------------------- ------------------------- <br />7 <br />Owner's Name ----- <br />------------- Phone ... - ------ 0 <br />Acicl4ss --------- 1140VA-11-J! <br />------------ --------- --------------------------- ---------------------------------------- I ----- <br />--------- I -­--------------------------- <br />----- -------------- ------- <br />Contractor's Name...__._ ... 1A&eV__ <br />------------ -------------------------------- -------------------------------- Phone ----- ------­--------- <br />Installation will serve: Residence Apartment House 0 Commercial [J{. trailer Court' � <br />El Motel 0 Other F] <br />Number of living units: <br />___/--- Number of beclrooms%�--- Number Lot size' — <br />Wafer ------------------ <br />Supply: Public system El Community'system.[-] Private R?"Depih-.to Water Tab <br />%,. le tov ft. :1 <br />Character of soil to a depth . of 3 feet: Sand E] Gravel [I Sandy Loam E] '.Clay Loam Clay El Adobe 9?'Trarclpan El <br />Previous Application Made: (If yes, date___.___..____.-_-_) No 2New Construction; I . on, Yes 2' No El FHA/VA;.Yes N <br />Jg-'o E] <br />TYPE OF INSTALLATION AND SPE-Qr-lf-ATlnK1C <br />(No septic tank or cesspool permitted if public sewer is available wifhin'200 feet.) -!o, <br />Septic nk: Distance from nearest jel _J - ------- f foun-dation---/V---- <br />Distanic To rjL_ <br />T <br />No. of compartments:__ -1 --- ------ -,d clep�� --------------- Capacity <br />q u <br />r <br />Disposal -eld: Distance from nearest well !.rr._._.D;stance from fobndation___/J� <br />Distance to nearest lot <br />Number lines --------- --------- ength of each line_�y'07 <br />-------- Width of trench ---- <br />Type of filter material__ __y, '---Depth of filter mafer;aI___1/T T - <br />_41 Total length ------ -------------------- <br />J` .0,( <br />Seepage if: Distance to nearest ell--liple -------- Distance) 0.' _Z_e'af /-0,2 D. <br />ion -.r.--. 07-c. D* f t "I line ---47-, .... <br />nce o nearest, q <br />_f <br />V Number of pits-__._ - IT ----------- Lining material____ ---- `-_D.�aTeter ----- -- -- ---------- Dept <br />S ze. <br />Cess ool: Disfarice.from nearest well ----------------- Distance from fo.undafion ------- :,r ------------ Lining material -------- ------------- <br />El Size: Diameter. ---------------------- --------------- Depth --- - ---------- -- ji <br />z ---------------- ->-----------Liquid Capacity.. ----­-------------------- gals. <br />Privy-. Disfance'from nearest wefl io <br />-.-Distance from nearest building ------------ -------- <br />Disfancefo nearest ]of line,_'- -, .- I ------------------ <br />---------------------------------------------------------------- ­ --- ----------------------- I ------------ ----------------------------- <br />Remodeling ancl/qr..repairing (describe)': I -------- ------- 114 - -- - -------- I ----------------­--------- ---------------------------- <br />------------------------------------------- I ------- <br />- --------------------- ----------------- ---------------------------- --------- r ---------------------------- I --------------- -------------------------------- <br />n.N <br />--------------------------------------- --------- ----------------------------------- <br />�j --------------------- 7 ----------------------------------------------------------------------------------------- <br />------------------------------------- j L '_- ---------------------------- <br />------------ ----------------------------------------- -------- I --------- I ---------------------------- ­­ -------------------------------------------------- -­------------------- <br />I hereby certify that I have prepared this -application and that the work will be dome in accordance with San 'Joaquin Coun <br />ordinances, State laws, an rules an requlations of the San Joaquin Loc'al Health District. <br />(Signed) <br />-----------­---------- -------------- <br />lt5L ---------- ----------------------------- (Quinsis a%diliar Contractor) <br />By: ---------------- _ 1. - I <br />(Plot P1 -------------------- ---------- <br />in r.lal ------- ----------------------- <br />an, showing size of lot location of s in relation'fo wells, buildingsi., etc'., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ------------- ----------- ---- <br />---- --- - ------ ----------------- ------------- -------------- DATE <br />----- I' ' 11" ----------------------- <br />REVIEWED BY-------- ' ' '1' <br />----------------- A <br />�i --------------------------- ------------------------------------------------------------------------ DATE ------ 1 <br />BUILDING PERMIT ISSUED ---ii ----­------------------ ---------------------------------- - ---------- ----------- ----------------- DATE.------------ -- ----------- d <br />Alterations and/or recommendations:-_____.___ ions, -------- ---------- Ii <br />------------------------ ------------- <br />--- ----- ---- --------- ----------­-----------­--- <br />--- ----------------- - ........ Ui;;-, --- C.. -- ------ ---- --- ------------------------------------------------- ­ ----------------- <br />--------- ---- ----- --- ----- ------------ �! ------------------------ <br />V ­­ . <br />10 - ------ ------ <br />---- ------ .... <br />---- - --- ----------------- ------ --- -------------------- --------- <br />r3 e9 <br />------------ ---------------- --- --------- ----- - --------------------- ---------------------------------------- -------- <br />---------------------- <br />--------------- -------- <br />- <br />FINAL INSPECTION B <br />------- ....... ------------------ -------- Date -------- <br />----------- -------------------------- <br />SAN JOAQUIN LOCAL -HEALTH DISTRICT <br />130 South American Street' 300 West Oak Street .1,24,.SYcamore Street k <br />Stockton, California- t� A - 205 West 9:fh Street <br />Lodi, California Mcinte .0, Ciallfol.rnic Tracy, California <br />E9-9 REVISED G -SP F.P.Co. ZM 6-60 15 <br />