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A <br /> FOR USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. .... ................ <br /> - ° - - (Complete-in Duplicate) _� - ?l <br /> Date issued J-__.._ 7..______ <br /> ------.--- � ' This Permit Expires 1 Year From Date Issued <br /> A licafionK'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. <br /> I� t <br /> JOB'ADDRESS AND LOCATION..� -- --- --r - -- - --- '------- ------- -- - - -- -�--�k----------- ---------/ <br /> Phone-- <br /> owner's Name 'y� -15=- -- <br /> y }Ali r -.....----••---------------------------- <br /> Address------------- - - � ��f���"' <br /> -�� �- r�R[Q <br /> �.� /yc-------------- <br /> Contractor's Name_. zfi !? - J.� --1� - �4".e---------------- Phone .3-W---- <br /> Installation will serve: Residence I`Apartment House [I Commercial D Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .._-- Number of bedroomq.J___ Number of baths-. __- Lot size .126..-.X.....�7 -- ----------------- ------ <br /> �i <br /> Water Supply: Public system Community system El Private L] Dept h to Water Table-d!0 ft <br /> Character of soil to a depth of 3 feet Sand E] Gravel [j Sandy Loam El Clay Loam El Clay El Adobe, Hardpan ❑ <br /> Previous Application Made: (If yes,d'ate-.------........... ) No ❑ New Construction: Yes No ❑ FHA/VA: Yes E] No E] <br /> 4 TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)Ill. Material . .� � <br /> Septic Tank: Distance from nearest well_I4D.l41e...Distance from f nd%tion. <br /> 11. <br /> No. of compartments.-. . Size: Liquid. depth_ ��_::---:Capacity-.- <br /> 1 Disposal Field: Distance from nearest well. p�t►� Distance from foundation__� ._ istance to nearest one... -..-.-.. 1 <br /> r }r 'r rye 'i <br /> Number of lines .�M.t�................. . ' .Length of each line-1 17__::;.4 .0.. ..Width of-trench_`.-.---------..-.-----._- <br /> k Type of filter material_ ' -..Depth of filter mate rial--s_1..�.---.....Total length___""/s 1 ----------------------- CA <br /> SIM; t' r , _�•� , . <br /> Seepa a Pit: Distance to nearest weIL .Q1 _......Distance.from'foundation--_J Q.._-- Distance to,"nearest lot line----------------- <br /> Number of pits:-:I ._-_.----.--Lining material_,J -----. Size: Diameter..- :f�.__--`-"-Depth... , �................. <br /> a l S _ wrs�„ <br /> Lining materiaT_�" <br /> Cesspool: Distance from nearest well ...-...�-.......Distance from foundation.._-- •---- <br /> ❑ Size: Diameter- .'I�' 111) <br /> --------- ----- --- ` Depth--------'�--- --- ---------- - -- ------------.Liquid Capacity- - ------------------------gals. -. <br /> i s <br /> Privy: Distance from nearest well...--..-_..._-__A�--------- Distance from nearest building- ...r _..................... <br /> a <br /> ❑ Distance to nearest lot lire ----- r ------------ - ---------------•---------------------------------------------------------------------------- <br /> if <br /> k IIS <br /> Remodeling and/or repairing {describe}:------------- --- - -------------•-- -------------------•------------------------- - <br /> I1 " ... _. -- -------- ------------ <br /> --------------------------------------------------------------- <br /> ----II <br /> r i ------------------------------------------- <br /> "- <br /> I hereby certify that I have prepared this -applicationVand that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta ws, and ruleba +jAl tions of thtTSan Joaquin Local Health District. <br /> Seplk.;Iaaenk SerAEf*1 ------ Contractor) <br /> (Signed)------- - } ----- --- <br /> -----(Title) <br /> (Plot plan, showing size of lot, location of system in relation to w Is, buildings, eq., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---.--- -� - - DATE - �. "4 ----------------- <br /> REVIEWEDBY------------------------- - --------1(-------- ._------------------- --------------------------------------------------------- DATE--------------------•--•------------------------------------ <br /> BUILDINGPERMIT ISSUED-------- -- --I11------------------------ --------------------•---- ------------------- --- ---------- DATE------ ---------------------------- ------- -- ----------------- <br /> F Alterations and/or recommendations------------------- <br /> 9M ---- ----------------------------------- -------------------------••---------- <br /> ------------I------------------- --------------- -I---••--------------------------------------------- <br /> ------ ---------------------------------- <br /> :I----------------- <br /> _= - = <br /> - --------------------- --------- <br /> -- --------------- ....... ----- ------ --- -------------------- - - ----------------------------- - -- -------------------------- <br /> - --------------------------- <br /> �l 1 .eY 2 <br /> FINAL INSPECTION BY:.. - ._` Date------- -- j <br /> .. _ t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street + <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />