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FOR 4DFFIC,EAJSE: <br />- ----------------------------- -------------------------- <br /> ----------I-------------------------- ----- ------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------ ----------------------- (Comple+e.in Duplicate) <br /> Date Issued <br /> ------------------------- ----- ............... ---- - --- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora permifrtofcQitrffcfr1� i�16+he work herein ceicribed. <br /> This application is made in compliance with C'Ounty Ordinance No. 549. <br /> tic <br /> JOB ADDRESS AND LOCATION------------------_---------------------- --------- -------------- --------- <br /> A: 7V <br /> Owner's Name------------HAA- ___LV1SA__'b_1DAa_Ik30-------------------- ------ --- ------------------------- - ---------- Plione-------- --------------------------- <br /> ...... - ------------------------- ------ -- ------- -----------------r- <br /> -- --- -- ------- ------------ ------------ <br /> Address.. At - --- W. 05, <br /> Contractors Name---- ---- ----- ---- ----------­-------------------------- Cone-" 07-- <br /> ------ <br /> t:l 114 <br /> Installation will serve: Residence Apartment House E] CommercialEl Trailer Court 0 Motel El Otherer [21 <br /> Number of living units: _V---- Number of bedrooms --Z-- Number of baths-I-- - Lot size - ...... <br /> ----------------- <br /> Water Supply: Public system El Community system ❑ PrivateM Depth to Wafer Table _7_s�7ff I <br /> Character of soil to a depth of 3 feet- Sand 0 G --,S <br /> rravel 0andy Loam 0 Clay Loam D.- E3— <br /> -Glay­ Adobei;� Hardpan F] <br /> T I r <br /> Previous Application Made: (If yes,date I No, New Construction: YesPn No� FHA/VA: Yes [:1 I NoGfl' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> (No septic tank or cesspool permitted if public sewer is-available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________DistanC� from foundation-__-___.___._.._.- Material -----------------------------------: <br /> ------------- <br /> 1,1-, 1 <br /> �e)CIS77, No. of compartments...__.... ................ `'`___A____ -----------Liquid.depfh ... .......Capacity----------------------- <br /> Disposal Field: Distance from nearest well...5-0- Distance f-ro ,foundaf.'ion-"-:-C'-7...Pistance to nearest lot line---7-47 <br /> Number of lines----- Length /$7 10• idth of trench---:24. --ff 1 <br /> ----- eng of Ac�h,.Vne_65tc------- -------W --------- -------- <br /> k It --------..Total length__I - _L�_)F;---------- <br /> Type of filter material._._.. .__Depth of filf6r,�m'hferial.-'�rIS-If <br /> 'f, <br /> Seepage Pit: Distance to nearest ­ Distance, om ud atibn-7157Z-7'r_rDist --tb-nedrest- __ <br /> tot kine_. -S <br /> C, <br /> Number of pits_ci.�........t.Lining maferial-_ -- Size: Diameter'-r.---3.3.!!,7. ---Depfh-.,v'7 <br /> --------- -- <br /> ---- --- - I I <br /> Cesspool: Distance from nearest well ________________Distance from foundNon---------_----- --Lining material__......_ .---------- --------------- <br /> I <br /> 171 Size: Diameter- -- --------- ----- ----------------Depth---------------------- <br /> --------- -------------------Liquid Capacity-------- ._._...____..'._.__gals. <br /> Privy: Distance from nearest wO..------------------------------ ----- ------ from nearest buirgi'ng---------------I--------------- ............ <br /> 0 Distance to nearest lot line------------------------------------------------- ---------------------I------------------------------------------I <br /> ------------- <br /> RWodeling and/or repairing (describe}:....Abbmeusi4L --- ------------------------- <br /> - -------------------j-------------''--------•--- <br /> j <br /> ---------- ------------------------------------------------------------------- ----------------------------------------------------------------- ------- -------------- <br /> ----------- <br /> -----------------1��------------------ ------------------------------ -------------------------------------------------------------------------- ------- ------------------------------------------- -------- --- <br /> ---------------------------------------- <br /> -----------------------;------------------------------------------------ ---------------------------------------------------------------------- <br /> -h <br /> I hereby cerci y'-that I have prepared this'applicafion and that the work will be done in'zkczo`rdance with San Joaquin County <br /> ordinances, State laws,and rules and regulations of the San Joaquin Local 'Health District. <br /> ----------------------------- ---------------------- <br /> ' (Signed)--- m Owner and/or Confractorl <br /> -------- ------- ------- <br /> .......... <br /> ------------------------- <br /> BY:----- ------------------------ - -------- <br /> (Plot plan, showing size of lot, location of rysf�e'yrn�iin relation to wells, buildings, etc., In be piacecll-on-rev6rse-sicl-e)�. <br /> FOR DEPARTMENT USE ONLY <br /> el 11, <br /> -3 _GY1 6�­ <br /> APPLICATION ACCEPTED BY.W_c kkz LN hk--------------------------------------------- ------ T -- - -------- <br /> ...... DA E_ �---------ff ------- -------------------------- <br /> i �------------------------- <br /> REVIEWED BY---------------------------------- ---- ---I----------- ----------------------------- ------------7!�--- DACE----------------' Q�1 1 <br /> ----------------- <br /> BUILDING PERMIT ISSUED-------- ------ <br /> ------------------------------------------------------------------ ------------- DATE----- ---------- ----- <br /> -------------- i <br /> Alterations and/or recommendations:.................I--------:-------------------------------- --------------I ------------------------ --------------------_---------------- <br /> - - ---------- ------- ........ . ... ----------- I li <br /> I - - - <br /> ....... ---------- - - -------- ----------NM.... - -t -- - -- -- --------- ----- - ---------------- <br /> ----------------------- ------------------------------------------- <br /> I ;-------------------------- --------I------------------------- <br /> ------------------------------------------ ---------- ------- ----------------­_­--------------------- ---------------- - --- ------------ - -------------- ..........----I <br /> I il---------- <br /> ----------- .........— r-- <br /> . .... ... ------- ----------------------------- <br /> ---- -- ................ ------------- -------1---------- ------- ---- ----------------- <br /> BY <br /> FINAL INSPECTION ...... ------------------------ Date_-. ------------------------ - -------------------- <br /> __SAN!,JOAQUIN-LOCAL-HEALTH,.DISTRICT_I-----­ <br /> 1601 E.Huxellon Ave. 300 West Oak'tfeet 124 Sycarnore Stre4t 2115 West 9th Street <br /> -i 111d ornio, Tracy,California <br /> Jilocklon,California Lodi. ICIWIA17�()- to n ?ZC40110 i <br />_E:Hr9z2M-1'567­VFn§da-rd Pre�is <br />