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-------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..,/5_-� <br /> -------------------------- ------------------------ (Complete in Duplicate) /Date issued ... <br /> w 7� <br /> _-------------------__-__.__.____._____________.___ This Permit Expires I Year From Date Issued <br /> _ . <br /> ... <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. F75-- ASO- Sia . <br /> 3ke3 _V, ,Ec.-.Dl✓A-4-4, .Sr , <br /> JOB ADDRESS AND LOCATION.t5r7.41ZH--_P V.-._H__I4!Y-.:T _t__ s.T.._... �...�C7 -----tnoSPtd--- ......*.......-&.406-. <br /> Owner's Name-----�c-Q------OV, ?.,:U...---.._..'_._ VF4.7–FY----oaF,14171�------••-•--------•-------------------- Phone.ft x4:5.9 AS----- <br /> Address---------- -- --I<.6........ ----------------•------.............................................................................................-------- <br /> Contractor's Name----0.d, .0C?e 5WAO V.V fOAI-r..__1�.o Y,ffl.�..----••-• -----•-------------------------------- Phone./-/&..0.fl..0t-7--- <br /> OP <br /> Installation will serve: Residence E] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �47oz� <br /> Number of living units: .........tNumber of bedrooms _______• Number of baths _A_. Lot size -__t��?_-__ ..................... <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 12-0. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe d Hardpan C1 r <br /> Previous Application Made: (if yes,date--------------------) No Effo" New Construction: Yes El"No ❑ FHA/VA. Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Qi? <br /> Septic Tank: Distance from nearest well_Z.00_1---Distance from foundation..../0.........Materia----C�� �! ........... 1W <br /> ® No. of compartments_____......9--------__---Size___sJ��___T_.c _�i_��___Liquid depth_______{�__y----------Capacity..63p&?....jp!Sl <br /> Disposal Field: Distance from nearest well..tea_`-._Distance from foundation____:!7........Distance to nearest lot line_.- <br /> Number of lines-------------- ------------------Length of each line.......54Q'-------------Width of trench----_Xy. .................. <br /> Type of filter mate rial..._J?.4'C"_AC-------Depth of filter material____.«'_"______Total length........V.I---_.__-_._••_•______--- ly <br /> Seepage Pit: Distance to nearest well _e4'!�"_'_.........Distance from foundation-_I__O.1........Distance to nearest lot <br /> Et Number of pits-------1-----------Lining material.-s_R_ __CC^�-----Size: Diameter-----�3-`•'_•.----Depth____._.2 `!,--------------- � <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> El Size: Diameter------------•-------------------------Depth----•-----------------------------------------------Liquid Capacity---------------------------.gals. <br /> 1 <br /> Privy: Distance from nearest well--------------------------- -------Distance from nearest building------------------------------------------ G <br /> ❑ Distance to nearest lot line__________________________ _ "-- <br /> Remodeling and/or repairing (describe):-----AV_cr2_JL4-----l_YS_rFA1.... . ._...dX��................ <br /> ------•---------------------------------------------------------------------------------...........--------------•..............................._---------------------------------------------- .....---•---------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws. and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------�r t/!< f' P1?Lf .. ----- `-----------------------------------�---�-.----�---(Owner and/or Contractor) <br /> By:---------- 0�*---C. - a .�...E-------------------------------------------------------...(Title)--.--- :.--- -•• ------•--.------ - <br /> -------------- <br /> (Plot plan, showing size of lot, Iota n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- f.C____ ._ —------------------------ <br /> -- -- ----- -- ------ ------------------------------------------- <br /> _ DATE___ <br /> REVIEWED BY--------------------------------- - --------•--------•--• DATE----------------••-----------------*................. <br /> ••-•• <br /> BUILDINGPERMIT ISSUED.........--•----------•--------------------•---•--------------•-•--------- _-------------------- DA•TE.----------------------•--•------------•-•------------------- <br /> Alterations an /or ree ommend'at' s:---------------------- ----------------------------------•---------------•---•---------•-------------•--•- ------...... . <br /> �/ /�'rr -.s.___.... .s.,r -- -�=�- `_----_ O l -- =r" 11.............................. <br /> r ----------- ---------...�1 r -f <br /> - 1­1- .. __-- . <br /> FINAL INSPECTION BY:....______ r---- <br /> f- - ----------------- Date---------------------------- .�--(---�----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB 9 REVISED 8.69 2M 5-61 ATLAS <br />