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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ­----- ------ <br /> ------------ ­---------------------------- <br /> ------- --- --------------------------�­ - - , __P_ I - - -(Complete in Duplicate) <br /> ­ . ­r� ­7--- ---- Date-I Issued ---- <br /> --------------------- --- ----------- -------------------- This Permit Ex I Year From Date Issued Y <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 application is made in compliance with County Ordinance No. 549. <br /> —*2 56- 5 1 PE_� <br /> JOB ADDRESS AND LOCATION----w-------------C V_6:�H------RD,-----3� _'P_ROOE�-------------------OF-----ZE4u__,S__ <br /> Owner's Name----------- I-------------------------------------------;--------------------------------- ------ Phone--- --------------------------------- <br /> E t---0 ----------------- <br /> ... j <br /> Address.........RT___ ; ---j r ---!;-7: ----------------- <br /> Contractors Name----Rn V-----13_0_vXI_N�----------------- Phone---------w-w----------------------- <br /> Installation will serve: Residence 12,' Apartment House r] Commercial E] Trailer Court E] Motel [] Other ❑ <br /> Number of living units:.--[--.- Number of bedrooms __/.3---- Number of baths -I ..... "Lot size ---- ------- <br /> --------------- <br /> Water Supply: Public system [-] Community system El Private e Depth to Water Table ft. <br /> Character of soil to a depth of 3,feef: Sand Z-,-Gravel [J_ Sandy Loom f__j Clay Loam E] Clay E] Adobe ❑ Hardpan C3 <br /> Previous Application Made: (.{f yes,date ------_ ------}"No-, Ne*-Construction'.-Yes-M-1q,0- <br /> [E FHA/VA: Yes� No El <br /> TYPE OF INSTALLATION AND SPECIFICATION' A <br /> � F- "" �. � -TG <br /> .(No'-septic,tank.orcesspporperri4edpu eweris available WM47166 feet <br /> Septic Tank: Distance from nearest weal____. ---',Distance from foundati $a ----- <br /> ZKI" No. of compartiments--------- ----------- cleptb----y/_ 1--___---------Capacity....AQP C7. <br /> I <br /> Disposal Field: Distance from nearest. IlDisfance' from founclafion_,_110---------Distance to nearest lot line___ <br /> _5 <br /> Number.of lines .-Length of each line----------�-7,0----------2-__0Widfh of-tr6rrcK=.3_( <br /> material___----OC)--,; Depth of maferial------- length--- ------ ----- <br /> Type of filter.m --------------- --------- <br /> Seepage P& Distance to nearest well---------------v?^Distance from foundation--------ee�Distance to nearest lot line-.----.__---__.__ <br /> Number of pits-----------------------LiningX41trial-------:--------- Size:PAiefer-------__-----------.Depth------ ---------------------------- <br /> Cesspool: Distance from nearest well----------------��Distbnce from foundation-------- ---------Linin material--------w----------------------------- <br /> El Size: Diameter-----------------------------:-------Depth--------_1----------I/ <br /> ---_------------------t-----Li uid Capacity----------------------------gal'10"t' <br /> lop <br /> Privy:: Distance.from.nearest well....------------ -----------------W--------/Distance from nearest building-------------- ---- ------------------------ <br /> Distance to nearest lot line- -- -------------- Y <br /> ----- ------------ --------------------------------I--------------------------------------------------------------------- <br /> Remodeling and/or repairing {describe')------------------------------------------------/........... -----------------------••------------------------------------ <br /> lvk <br /> rn <br /> ----------------------------------------------------------------------------------------------- -------------W----------------W-------- -------------- ---------------------------------------------------- <br /> -----------------------W-W------W-W--------------------------------- ------------------------------------- ------------------W-----------------------------------------W------W­-------------- <br /> I I , <br /> ------------------------------- ---- ----W---------------------------------W------------------------------------------------------------------------------------------ ---------------------------- --------- ------- <br /> - <br /> I hereby certify I igait I have prepared this application and +Af the work will be clont in accorda�nce with San Joaquin County <br /> N <br /> ordinances. . e ws, and rulesan Joaquin Local H <br /> ,�?regulafions of the San J ealth.District. <br /> (Signed VI <br /> ......... ------------ ------ ........ --------------------------------------------------- J.Owner and/or Contractor) <br /> , y:,-- ------ - - - - - <br /> � - -----(Title)----- - ----------- <br /> (Plat plan, showing sixeof lot, Iocati-n of sysfem.inrelationJowelIs, buildings, etc,-can be placed on reverse.si <br /> FOR DEPARTMENT USE ONLY <br /> -----------3 <br /> APPLICATION ACCEPTED BY--- _�-K-,_0----------------------------------------------------------------- DATES--- <br /> i7�w--------------------- <br /> REVIEWED 'BY------------ --------------------W-------------------------------------------- ------------------------------------------- DATE----------------------- <br /> BUILDING <br /> ATE-----------------------BUILDING PERMIT ISSUED__________________________ ------- ---------------------------W---------------------------- DATE------------------------------------------------------------- <br /> Alterations <br /> ---------------------------------------- <br /> Alterations and/or-recommendations.---------------------------------------------- --------------------------- <br /> ---------------------------I------ ------- ------­-------_---------­----------- ----------------------------------------------------------------------------------------------------------------------- <br /> ---------- --------------- ------------------ ------------------- -------­-------- -- ----- ---------------------------------------------------------------------­----------- <br /> --------------------------------------__---------W - ----------------- -------------------------------------- <br /> -------------- -----------------W---:--------------------------------------- <br /> ------------ ---------------------------------- - - ----- - --------- - --- ------ ---- ----- -- ------- ----------------------------------- ---­-------------------------- -- <br /> FINAL INSPECTIO -------- <br /> Date----- ----------------------------------------- <br /> a e------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazolion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad!,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 3M 3-'63 F.P.00. <br />