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FOROFFICE USE: <br /> --------------------------------------------------------- APPLICATION `MR-'SANITATION PERMIT Permit No. ..1. -. 1 <br /> -- ------------------ ------- --------------------------- (Complete in Duplicate) 17 <br /> ----------------------------------------------_.- --. This Permit Expires 1 Year From Date Issued <br /> Date Issued ....��.....:..�.Z <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 /> JOB ADDRESS AND LOCATION- ... ------------------ -----�,�!-------------•---------•---------------- <br /> Owner's Name---------- .......... .................................... <br /> ------------- <br /> 1�i <br /> Address.....................,�.�ttl....--•- -------•-•--------•- --•---•---••-------------------••-----------------------------------------------•-------------•-•--------- <br /> --------,.--�---------- r------------------ <br /> Contractor's Name--------------------y�0�1.-�le,0�.��r--------------------- . -- Phone.............................------ <br /> Installation will serve:Number of Irving Residence <br /> siids uni <br /> ts: <br /> Apartment House [:1 Commercial [3 Trailer Court ❑ �Ig} ! Q /,ther ❑ <br /> Number of bedrooms _ ..... Number of baths J_..- Lot size _ <br /> Water Supply: Publics stem Community system Private De th to Water Table ft. <br /> # <br /> ,t Y ❑ tY Y ❑ _� P <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: [If yes;date.............. ....) No New Construction: Yes g]--No E] FHA/VA: Yes 2 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> \(No septic tank or cesspool permitted if public sewer`is available within 200 feet.) <br /> Septic an Distance from nearest well----•10.'_ fDistahce/ffpm fo+yn dation__/ ------------Mate;al--A..�.-��.�.... .....__.__.. <br /> [ compartments mems._._. ------------- .Size:tii2'.X. p_.:-.-.___Liquid depth---- <br /> _ <br /> -_-. -.-Capacity__ 0�.._.. <br /> Disposal Field: Distance f ornnearest well.%,$-,.mJ�,r.__..Distancefrom foundatio ..f ___.......-Distance to nearest lot line _....... <br /> ... .,. en th of each line._:- ------------Width of trench.... '........_._. � <br /> Number of lines..:...._ ' r.. -----.r g <br /> �''�Type of filter material. ' epth of,,filter material.....Z--f------Totals length_...__? _ ..._..._ <br /> ----------- <br /> Seepage Pit: Distance to nearest well____A�i2----_[_Distance fr m,foundat�ion...1/0 ......Dista'nce to nearest lot line._t...*..... <br /> Number of its. <br /> '! <br /> p . Luning tnatenal . . .fit - -_-----.Size: Qiameter-_ -- '-------Depth---. ., -.--------•-----_._.-- <br /> j 1 <br /> Cess ool: pisttince from nearest well_ from foundation -- --..Lining material_..-....-------.___-.•_-------.._--__ (\� <br /> ❑ Size. biameter--.=---------------------• - ',. 1Depth---------------------------------- t;_-�; Liquid/Capacity...........................gals <br /> '* _. _- ' <br /> Privy: Distance from nearest well.............. .....:.........._....------_-_ istance from neares bdilding-............------.._-....__------._...-. <br /> ❑ Distance to-,nearest lot line-------------_%-------•------------------------------- --- -----------------•------ -------------- <br /> Remodeling <br /> -•--•------.-... <br /> Remodeling and/or repairing (desi~ribe):------ -----�_'- - ------ --- --------- L......c------------------ -----•---......... <br /> �� ;; _ _ _ _�_ yv I <br /> ........................ ----------•---------....'---------- -_ .1 . <br /> >- � . <br /> ! / . t 1 <br /> 1 i <br /> ----------------------------------------------------------------------- ........................_------------------- <br /> I hereby certify that I have preparedrtbis application Wand that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the Sen Joaquin Local Health District; I �/ <br /> (Signed) INF }' Contractor) <br /> Y•.................................................• ;--3 1------- - -•- -----••---------------------- -------...---. ..-------------- <br /> (Plot plan, showing size4 ff lot, location of{syst to relation to wells, buildings, etc., can be;placed-on reverse side). <br /> � r <br /> \ t I FOR DEPARTMENT USE ONLY <br /> -i 4 • <br /> APPLICATION ACCEPTED BY- � �: _ --------------------------------------------------- DATE...... 2- <br /> -- .... ----- <br /> REVIEWED BY----------------------- ---- - f �> _"" - `----------------.- DATE--------------------•----•-- <br /> -----=k- ------------ <br /> BUILDING PERMIT ISSUED----------`v.... ------------ DATE------------------------------- <br /> --.....-• <br /> Alterations and/or recommendations:------{------------- ---------------------------------•-•-------------------------------•------------•------------------------------------------------------ <br />- <br /> - <br /> ...,s - ----•-- -------------- --•-•--••----------••-----•------------------•--------------.......---------------------•---•-•-•--..._ <br /> - � Sid@��L�y+� ��{ . <br /> r •..:...._... ---­------------------- <br /> ------------------------------------ <br /> FINAL INSPECTION BY:_-- --- - - • --- ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strout 300 wast Oak Street ,y <br /> 124`Sycamore Stud 285 wast 9th Strut <br /> Stockton,California Lodi,CalifainiaMentaca,Capfornia Tracy,California <br /> E6 9 REVISED 8-89 YM 15-61 ATLAS <br />