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F-R OFFICE USE: <br /> Y______ APLICATION FOR SANITATION PERMIT --Permit No. _L_Z_J_- ._L <br /> _ _ Z . ....-_ ` Com late_in bu hcate <br /> _ _-(• - - - p _ ) . ._... Date Issued -a1.7 , <br /> ,l S� <br /> 4r. _. __--_ - ,�__- This Permit txPires 1 Year From Date Issued <br /> Application is hereby ma a to the-Son 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 AN LOCATIO f __ ' -- -------- ----'��. --- --------------- <br /> ...Y. <br /> •----- - <br /> Owner's Name-,---- � �. r 4--1------------4=- =------------ <br /> ----1------------- 'Phone-�----= ---c- <br /> --- <br /> ---------•----. ---- <br /> ----- ------------Address . --------- <br /> Contractors, N me--- ' -------- ---- 1-----------�.. . ------- -----= ------- t" -- ----------- Phone--••----•-------�'------------- <br /> Installation will-serve:- <br /> ]Residence ❑. ApartmentlHouse ❑ -Commercial ❑ Trailer Court Motel ❑ Other <br /> Number of living units: _.__- N .'._ber of;bedroorris_,�':;,wNumber of baths—3___ Lot sizo"i: GiC�k� <br /> Water Supply: Public"'system Community system ❑ Private ❑ Depth to Water Tab I4i�_ ft. <br /> Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ San Loam E] `Clay Loam'.[] lay-E] Adobe ardpan ❑ <br /> Previous Application Made: {If yes,date._ .._.-_--._._) No New Construction: Yes y o ❑� FHANA: Yes ❑ No ®� <br /> k rc ti' <br /> TYPE.OF4NSTALLATION AND SPECIFICATIONS: <br />} �."(No,septic tank or cesspool permitted if public sewer is available within;200 feet.[ <br /> li Septic nk Distance from nearest well '_______Distance fr fou dation_--Q.__-_.___.Material_ 01--a____-______ <br /> No. of compartments_________________________Size___ _�_-__-_-.1�iquid depth---�1,,�__.7-�---...Capacity �__./______ <br /> bi of.Field: Distance from ne r t w�Ji._`. ___._:Distance from foundation__ _� _-________.Disfance to nearest lo} li�e.--___.__,__ <br /> ` P{ Number of lines____ _ __ _____ ___._-___�w__Length of each line'?r� 1_r_ 'i _.Width of trench_�.�__�__,-_______- <br /> `rJ :�_ _ De th of filter material_ !-_-_-__._Total len th _'N_ .- .�'�� <br /> I os <br /> Type of filter matenaL_) p , l ' / g �. ,T-__--._/__.__ <br /> �Seepa' Pit: Distance to nearest well------ ---- ��_-_______ . <br /> Distance• m oundation_ Distance to nearest lot <br /> Number of pits-----3------------Lining material_ ,__size: Diameter-----3.3-9 R r„— ___-- ___ U1 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------- <br /> I ❑, Size: Diameter. ------ -------------- Depth _----------------------------------------•-Liquid Capacity----------------------------gale IrZ <br /> Privy: Distance from nearest well----------------------------------------------_-_Distance from nearest building-___________________.__________-____.__._. + <br /> ❑ Distance to nearest lot line----- --------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing ( escr,• ---- { = ----------=--------------------------------•-------------------------- <br /> --•--• ------------------------------•-------------- -- ------- <br /> ---- = --------- �t <br /> -------- ----- - +.yl <br /> _________'____________________________________.____._____-___________-__________________.___.---____________.-_-----______-_--_-._____________.__F_________--___.______________________-_____________.____,______-._.__.__-._..._ <br /> I:hereby certif hat I have prepared this application and that the work will 6e-'done in accordance with San Joaquin County- <br /> t ordinances, State la s, nd rules a regulafions of the San Joaquin Local Health District. <br /> [Si ned Owner and/or Contractor <br /> g � )-------------------- --- ----------------------:- --------------=-----------------------------•------- [ t <br /> By: =---- (Title)---- --- ----- - <br /> (Plotplan, showing size of lot, f a ion of system gnelation,towwel1s, buildings,Yetc.,.can,be-placed on reverse-side).-­ <br /> Plot <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ 7 �-� <br /> ----- -�-- -�-r---�---------------------- --- ---- - --• -------- ------- -- -- DATE------ <br /> REVIEWED <br /> - ---� ----------------------- <br /> 1 REVIEWED BY --------- - --------- <br /> t --------------------------- ...... DATE--------------------------- - <br /> BUILDING PERMIT ISSUED------------------------------------ ------ i---- DATE---------------------------------------------------- <br /> A1ter do and/or ec mme dation : <br /> fn a' R - �'------------ <br /> -- ---- -- -- <br /> -------- -T------ �� = ------------ --------------------------------------------------------------- <br /> ,�a « - -------------------- <br /> �---- - --- -= --------------------- <br /> --- ----------- - <br /> aa, <br /> FINAL INSPECTION.. BY-------------S�.7 _C��--------------- - Date----____.�� ��,'-.-.�n-------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselt6n Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> F } <br /> Stockton,California �" x .Lodi California '' f1 Manteca;California Tracy,California <br /> ES 9 RCV16E0 a•S9 3M 3•'63 r.P.00. f <br />