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FOR OFFICE USE: <br /> _t------------------------------:i=--- <br /> -- J- -- <br /> APPLICATION FOR-SANITATION PERMIT Permit No. <br /> ------------------ ------------------------------ - <br /> ------- ---------- ------ -------i --- (Complete in Duplicate) <br /> Date Issued <br /> ----------------------------------------------- <br /> ----------- This Permit Expires I Year From Date Issued <br /> ----- ------ - ----------------A I <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. 54,9. 2�7_p LOAJ <br /> JOB& <br /> ADDRESS AND 'LRT_I§N/])F____CkA).&--------_150_0.......... ��A-na --------IRV------- U.4 <br /> - <br /> Owner's Name----------------My6RCj0__S------------0-44-va'.. - IL JS) <br /> ------------ ---------------------------------------------------- Phone--------- <br /> - ---------- <br /> 7 <br /> Address---------- _TF =j- __j3!2_K <br /> - ----------�Q----------EGC_a_4�0./V2- <br /> -------------------------------------------------------------------------------------- <br /> Contractor's Name----!2W44'_F—._R---------------------------------------------------- ------------------------------------ --­ ---------------- Phone.----------._ :�----------------- <br /> I :--- I � <br /> Installation will serve- Resid I encej�j�partment House 0 Commercial [:] Trailer Court [:1 Motel Ej Other ❑[] ' , <br /> Number of living unitl: .1------ Number of bedrooms -3.- Number of baths 1- —Lot size ---------------�%------ <br /> li Y-'Z <br /> Water Supply: Public system 0 Community system El Private 0-`6`epth to Water Table ;?__�_ ft- <br /> Character of soil to a depfh,of 3 feet: Sand E? .Gravel E] Sandy Loom E]j Clay Loam E] Clay E] Adobe C3 Hardpan 0 <br /> :f-I --- kxl� .1 <br /> Previous Application Made: :1 06es,date--------- ---...--..--)-No,PR----New,Const.roction: Yes Er'--No [-] FHA/VA: Yes E] No E--_ <br /> TYPE OF INSTALLATION AD-SPECIFICATIONS: <br /> 6 <br /> -�p2er�miff4�id-:if;�p�u6lic'se-ii-ir--i-s i-iiiii lg'within- - 200- ed <br /> Septic Tank: Distance from nearest weC_50....Dista e from foundation-____L _______-M terial----Coac-pue-T- <br /> `­7 ------ <br /> No. of compartments_- depth_ -----—------- -Capacify.,__Y!�7------ <br /> Disposal Fielcl:'\ Distancelfrom nearest-well.7.50------Dis-ia-rice-from foun6fion----1-0----------Distance to nearest lot line---- 571e� <br /> Number'!of lines--------2- <br /> ----------------------------Length of each ----_.Width of trench---------B-6... .. <br /> ... ............. <br /> L�hl <br /> Type oijilter ma+erial._RO_!�;_K�-------Depth of filter ma'le'rial------/. /-----------Total length--------- ------------------ <br /> Seepage Pit: Distance,'-to nearest well-.--------------------Distance from founddfion------------------- Distance to nearest lot fine-.___.____.____._ <br /> ❑ Number..'C I <br /> f pits------_ -- <br /> - ----------Lining material----- -•--------------Size: Diameter-----------------------Depth------- ----------- <br /> Cesspool: Distance' from nearest well-----------------Distance from foonO'ation--------------------Lining material-------- ---------------------------- <br /> Size: Diameter---------------- _ -Dept h................... --------------------- Capacity------------------ ---------gals, <br /> Privy: Distance from nearest welr-----------------_______________________________Distance from earesf building___.____.._____________--_.-.--.-----.._. <br /> ❑ Sto <br /> uilding--------------------------------------- <br /> Distanceto nearest lot line--------------------------I , - -- - <br /> - --------------------------------------- ------------------------------------------------------------------- <br /> -:., �� 4 <br /> Remodeling and/or repairini) (describe):--------- iA U-i <br /> 9 -------------------------------------------------------------------------------------- -­----------------------- ----------------------- <br /> ----------------------------------- ------------------------------------------- ------------------------------------ ------------------------------------------ <br /> 11 I <br /> -----------------------------------------------------------------------------'i---------­­------------------------------------------------------------1-------------------------------------------------------------------- Afi <br /> ----------------------------- 11 ------------------I--------------------------------------------------------------------------I-------------------------------------------------------------------­ (0 <br /> I hereby certify that I have prepared this 7p�iic-aifio;;Td'that theworkwill be done accordance with San Joaquin County <br /> ordinan to laws, and rules and regulations of the San Joaquin Local Health District. <br /> 1� N 0 <br /> [Signedl -------�_ _ -------------------------------- -------- ---------------------------------------------[Owner and/or Contractor) 7 <br /> -------------------------------- --------- <br /> (Plot plan, showing size of lot location of system in relation fo wells, buildings, etc., can be placed 6h-reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED !:By--------- ------------------------------------------------------- DATE------ ---------------------- <br /> REVIEWED BY - <br /> ------------------------�1- <br /> 7 ----------------------------------------------------- ------- --------------------------------------- DATE--------•--------- LA------------------------------------ <br /> BUILDING PERMIT ISSUED- ---------------------------------------------------------------------------------------------------- DATE--------------------- <br /> H ------------------------------------------- <br /> Alttions and/or recommendations:------- ------ -- ---- --------------------------------------------------------------------------------------------------------------------------------- <br /> ----IVLJ_7.&� ------------ ------------------------------------------------------ <br /> -----Y-_id--=67----------- _MR_f>------ ------7-HA-r------*y.tTr;=M-----/s--- <br /> 4-_05-----UND aA___P :W!--T_.H------ <br /> PE Penn i T- -rc F I N'ii�_H I-F-R Lk J=I I--"C) I VVO U <br /> E ijv 15Erl 4 <br /> A15 T74N K so , I_F_4c+H : LI Fj F_ <br /> FINALINSPECTION BY: -------------------------------------------------- ------------ Date---------- ---- --------------- .......... ------------------------------ <br /> I1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ii <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Trefty, California <br /> ES 9 REVISED 13-59 3M 3­63 FACD. <br /> -T H t -Ff Al f-= --Ty R <br />