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t <br /> FO <br /> OFFICE USE: ' Ar7 A 4217 , r "r�r.,: s � <br /> APPLICATION-AOR SANITATION PERMIT -• .;� rmit-No. .:. <br />--------, ------------ -_------------------------ (Complete in.,Du�tg] • , >�...y a ti- � � l <br /> Date Issued. -:---- - --.-�- -- � <br /> --.-- E11. "-------------- This Permit Expirewfitigar FroU% f <br /> Application is hereby made to the San Joaquin Local Health District for a perm; :aronstruct and install the work herein described. <br /> This application is made in iCompliance with County Ordinance . 549. <br /> �,�r <br /> JOB.ADDRESS AN O�'ATI N------ --- 3 �. _ ' ------ ------f ---------------------•-•-------•--------------------_----- - <br /> -- --- ------------------- <br /> 1 <br /> Owner's Nab@ J t - r - = ._ :� _.- - -- ------ -----------------------------." ------- Phone---,..--*-------------------------- <br /> - <br /> K <br /> Cor,�ra��o .s Name_--��------ ---� ��----- x Qhone..... <br /> Installation will serve: 't Residence artment House ❑, Commercial-❑ Trailer, Court ❑ Motel ❑ Other ❑ <br /> " ' ......... - --------------.----- <br /> Number of living unit�:, �_----- NurS. er ofedrooms ..Number of baths _- _-- Lot'size ------------- -- <br /> Water Supply:SPublic;,systekW?--Cor munity system [_1Private F1 �Depth.to Water Table <br /> Character of soil to a�el ,p 3 feet: Sand E] Gravel E] Sandy Loam 0 Clay Loam ❑ Clay❑ Adobe [ '�lardpan ❑ �J�i <br /> Previous Appliicaation. Made: (I yes,date- -------------- No�New Construction': Yes ;p!r-No ❑ FHA/VA: Yes ❑ No <br /> TYPE-OF INSTALLATION*AND SPECIFICATIONS: , <br /> ` (No septicaianksor"ces'spool permitted if public sewer is available within 200 feet.) ff <br /> • ;`� Distance from nearest well-+r--Distance from. f6undation----- -d <br /> Septic T _ - C� <br /> No, of compartments--- -.-____--___rSize- x _-? _ -.___Li uid de th_-_-4.-__--...-----:Ca�acit e- <br /> I i P q R P Y-,- �� <br /> .. i i <br /> n <br /> Disposal F' d: '0' tante from ne est well --^--^-. Distance from foundati-� Width <br /> ce to nearest of lin�e_'�- ------- <br /> am <br /> ►� �' ! .Length_of�eath_.liae---: Distance to <br /> Ni of-lines - C� — h of trench- -------0_- ----- ----------- <br /> TYpe.of filter.i-nrial-__ L-'�- -Depth.of filter material ----- length-_____C,:;�L_O--------------------------- <br /> # f/ <br /> V Number df its46rest <br /> ---_— �L:.n material----lL.�°-C`- Size: Diam ter-•_j-Y ----De th_--- �_:-� �` <br /> Seepage Pit:. Distance o.nearest well___- Distant om foundation-_ <br /> - Distance to nearest lot line_- :.-.--_ <br /> gam` .. - �- - - p � � , <br /> p - Depth '---:-.-----i ------------------------------------Liquid Capacity1------'-•--------------- ------ l <br /> Size: Diameterfiw��.---------___.--- _---} ° , _. 'nearest. - <br /> Cesspool• Distance from" well-------------- _Disttance from:foundation--.._._._._.- - Linin material <br /> gals. <br /> • Distance fs building----------------------------- <br /> : , <br /> Privy: Distance from nearest well----------------'------__.__.___--__---.-_--_-.- <br /> y: <br /> Distance to nearest lot line--------------------- ------------------I IP--------------------------- <br /> Remodeling and/or repajsing .(describe)--------------- <br /> ------------------------------ ------------------------ --- -------- "� -- ---- . ------------------------------- <br /> f t s <br /> •a <br /> - --: -- <br /> -------------------------------}-- ----- --- -$ -------------------•----- -{----'------:----••-------------------------`-------------------•-=------------------------------------ <br /> 1 <br /> -- -------- ----- <br /> -_--- ---------- ----'a --------------------------------------------------------- ° - -_----------------- <br /> ------------------------------- --- ----- - <br /> � ereby certify that I have prepaied tk]s ap t ation and hat the work will b$,�clone to accordance with San Joaquin County <br /> y o``dihances, State laws, and rules and regularto the Sa oagt4n ccal Health, lstrlct t <br /> ( - t <br /> � .. <br /> {Si ned e:--. ` ---------._.----:-`=Owner and/or Contractor <br /> g = -------------------- - ' <br /> .. <br /> 13 1 9 --------------------------- -------------- ----------- -.--- --------- � . <br /> Y'--------------s•---- ---=--...---- ------------ ----=- ------ ,- =�� ---------- --{Title)-- --:-�`:r.-' � - - � ! <br /> {Plot plan, 'showing size_of la+.,_lot ton�ofsyst :�elationla:w.ells,�buildings,_etc.,_can.be placed on reverse side). <br /> FOR DEPARTME-Nfi'USE ONLY <br /> 4 DATE-------------------------- <br /> W. ----------------------_. <br /> BY' E= TED BY--------- ,_ 4!' ------ ----- ---------------- ------- DATE ,� ��-L ----------------- <br /> -------- <br /> - - <br /> APPLICATION ACC <br /> 6 -____- -•--:�---------------'--" -------"---a---•_____________•---__-_-•-- ---___-__. --------- <br /> REVIEWED <br /> ----------------- -•4_-•--------- <br /> - ------------•--•_ <br /> BUILDING PERMIT ISSU D_.- : --------- ---------------------=------ = DATE <br /> Cha-------, - <br /> -`Alterations and/or recommendations: -------------------- '---------------------------•---------- -------- -•---------•----------------- ------ <br /> r - <br /> ,� , <br /> --- --- <br /> - -- <br /> - ,. T <br /> FINAL INSPECTION BY:..---:t..-:.C.--.. C..E� = Date- ' , X ..... <br /> - <br /> �,:, " SAN.'JOAQU.IN1OCAL HEALTH DISTRICT <br /> IGOFHa:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th stref-ie­ i <br /> K Stockton,California. -Lodi,California Manteca,"California Tracy,California <br /> ES 9 REVISED 6-59 31A 3-'63 k,P.CC. 1-4 <br /> t elf <br />