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FOR OFFICE USE:'' <br /> ------------------:---------:­------------------------ " Permit No. I <br /> .x �_� -rel-_- <br /> APPLICATION FOR SANITATION PERMIT -- <br /> --------------------------------------------- ----- (Complete in Duplicate) — <br /> --- --_ This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the rk here-- djaps ribed. <br /> This application is made in compliance with County Ordinance No. 549. k.yr p�r3_�Q dS �p,�� <br /> JOB ADDRESS AND LOCATION_f,/ J/ 0__l-_- me-owr---4�&Ogn.r----57;_O( --G fl? /Y15-----_J�G', <br /> Owner's Name ------ /.+G ,.�p � .l ------------------- - Phone.-------------- <br /> ---------- -- -- - --- ------- - --- -- ---- ----- <br /> -------- <br /> Address -- -----.__e_x7-pp z_- -------5_74� /Q� -------------------- <br /> Contractor's Name_________ ____ <br /> i------------------ ----------------------------------- ---------------------------- Phone---------------------------- <br /> Installation will serve: Residence R--_Apartment,House,❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1__ Number of bedrooms _� _ Number of baths 0__ Lot size _. r�G �r - --------------------------- <br /> lo <br /> Water Supply: Public-system Community system' Private ,.,,"De th to Water Table eft. <br /> PA Y� Y ❑ Y Y ❑ L� , P � - ►► <br /> Character of soil to a depth of 3 feet: Sand ❑�`Gravv9I Sandy Loam ❑ Clay Loam ❑ Clay dobe ❑ Hardpan ❑ q <br /> Previous Application Made: {If yes,date._ _U/�_`]'No ❑ New Construction: Yes �o ❑ FHA/VA: Yes W?'--No ❑ p <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or.;cesspoal.permit+ed if pu6�lic se _is.availa6le_within ZOO.feet.)� <br /> e t Distance from nearest well__S0a j ta,+n�t�e from foundation _X�--------Material..C.�_��.:_ �_______ ------ <br /> . _ <br /> No. of compartments_. ____._ ____.___ -zead_ >� _ Liquid depth___ _ --------------Capacity/Z--4--- _ <br /> i� -_• <br /> -e Distance from nearest wei#S _�yWistance from foundation--_.Z ---/..-.Distance to nearest lot line------_"- -_-- <br /> Number$of lines---- __-__ ___ Length of each line_ee_�--._----......Width of trench_�._/__� <br /> Type of filter material Qfi�-Depth of filter material---AP--_-------Tota4 length__,r2_Ap--------------- ----=-- <br />- Seepage Pit: Distance to nearestweIJOD A: from'foundation_%Z0----------Dis a ce to nearest lot iin <br /> =777 <br /> Number of pits-----oU_------------ _Hing mater-a1__1��&----_Size: Diameter _.__._._____.Dept h- __.____.______.____ <br /> Cesspool: Distance from nearest well-----------------Distance fromfoundation--------------------Lining material------.._._--__--_-______ <br /> ❑ Size: Diameter--------------------------------- <br /> ---------------- -------------- ----Depth-------------- -------------------------------------Liquid Capacity----------------------------gal <br /> s. s <br /> Privy: Distance from nearest well____-----------------------_---------------_-----Distance from nearest building__....____._.___________._.___.__.._____. <br /> ❑ Distance to nearest lot line------------------------ ---------- <br /> Remodeling and/or repairing {describe):-------- ;--F`V, ----------4- ----- <br /> ------- --------------------------------------------------- <br /> 4------- <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 Joaquin Local Health District. <br /> (Signed)-------------------------------------- ----- --- - ---- - -- -- ----------------- --- ------------------------------------------( r Contractor) <br /> By:- ------------------------------- -------------------------------------- i = a-v� TiVIA.. <br /> (P9 to pan show'�ng ize of lot, location of system in rela to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- - ----- ----------------------------------------------------------- DATE---------- ----11=V1(------------------------------ <br /> REVIEWEDBY---------------------------------- - ------------------- -------- --------------------------------------------- DATE---•--------------------------- --------------------------- <br /> BUILDING PERMIT ISSUED---------- ------------------------------------------------------•----------------------------------- DAZE--------------------------- ----------------------- <br /> ..A <br /> Alterations and/or recommendations--- ------------------------------- ----------------•---------------------------------------------------------------•---------------------- --------------- <br /> - - -- --- ----------------- - ----- --- --- ----------------------------------------------------- <br /> -- ` <br /> ----------------------------- - ---------------------------------------------------------•-------- ------•-------•-------------•-------------------------------------------------------------- ------ ---------------- <br /> FINAL INSPECTION BY. ------ -------------------------- Date J.R_ l`'4�------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave. 300 West Oak Street R 3 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California 4 " Manteear Calif mania Tracy,California \1 <br /> F.P.CO. <br /> M � <br />