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FOR OFFICE USE; <br /> — <br /> APPLICATION FOR 'SANITATION PERMIT Permit No. <br /> ------------------- ------ <br />---------------------------------------------- ------- (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Thlipapplicationeisemade�n compliance Joaquin ce No. 549r a perricf mit mit to construct and install the work herein described. <br /> JOB ADDRESS AND LOCATION--- 4;7�------ r / ------ <br /> Owner's Name-------ai +rte•-�' Q------------------------- --------------- ----------- - ------- Phone------------------------------------ <br /> Address--------- --------�e --• '- <br /> /'19f� . - <br /> I <br /> &� � .----�� - ---------------------------------------------- -------------------------------------------- <br /> � <br /> Contractor's Name------- = 40-7-to- --- -------- ------1-------------------------------------------- Phone....----------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -0.:. Number of bedrooms _,Z7 - Number of baths__ .. Lot size -6`.' 7-%$4-- V <br /> Supply: Public system e"ommunity system ❑ Private ❑ Depth to Water Table e_ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ <br /> Previous Application Made: (If yes,date_-..... ) No New Construction: Yes ❑ 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.) <br /> 5�ptie Ta Distance from nearest well---------------..Distance from foundation-------------------,Material ------------------------------------------------ <br /> �eflWf No. of compartments-------------- -----------Size---------------- --- ---- -----Liquid depth--------- ---- ---- ---Capacity---------------------- <br /> Disposal Field:i Distance from nearest well.. ...��......_.._Distance from foundation.,oe/A........Distance to nearest lot line-�...----- <br /> --------- <br /> r <br /> 07' Number of lines -. g - <br /> f....- Len th of each line--- _ .--- Width of trench.9---------------------------- <br /> - <br /> Type of filter materiaDepth of filter material---- -41 dotal length--- -------.------------------- <br /> See age Pi . Distance to nearest well........ ---------Distance from foundation___.1-110'el-r_.f...Distance to nearest lot line-07..* <br /> Number of pits_. ...............Lining rrlaterial/ ,P ._ Size: Diameter-, ...... Dept `----------.-.-------- } <br /> (�_,s*i Distance from nearest well ----------------Distance from foundation------........... ..Lining mater ial--------.-.--------------------------- <br /> ❑ Size: Diameter- -- -------------- ----------------Depth--------------------------------------------------.-Liquid Capacity-------------- -------------gals. <br /> Privy: Distance from nearest well--------.------- --------------------------------Distance from nearest building-------......----------------------------- <br /> ❑ Distance to nearest lot line - --------- ----------- -------------------------------------------------------- ----------------------------------------------------- <br /> Remodeling and/or repairing (describe V.r----------------------------------------••----------------------- <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)---------------------Ae �---' -1 -- ---- - - --------------- ......---- . -- -tGk*rtev aa44or Contractor) <br /> ---{Title) � �. -- -- -------- ---- -- <br /> (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be,placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ --- ---- ------------------------- ------------- DATE-------S-a4:7 ------ <br /> REVIEWEDBY--------------------------------------------- --------------------------------------------------------------------------- ---- DATE------ ---------------------------------------------------_ <br /> BUILDING PERMIT ISSUED-------- -- ----=----------------------------------- ------ ------- ---------- ---'-------- ---------- DATE------------------------------- -------- ---- -------------- <br /> Ir <br /> Alterations and/or recommendations: ' ------------------- -------------------------------------------- ------------------------- <br /> ----------I—----------;--------- <br /> ----------------------------------------------•--- ---- -------------- ------------ -- - - - ------- ------------------------------------ -- <br /> ----------------- --------------------- ------ ----------- - - ----- -- <br /> ------------------------ ----- ---- - -------------- ------ --- ------ - f ---------------------- --- ------------ ------ <br /> FINAL INSPECTION BY:.---------- �l ` -- ------ Date-- ---- 3~ .--� ..........I------------------------------------ <br /> SAL/ JUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />