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1-UKUrHCE USE: <br /> 1 - 1 -------------------- <br /> -------------------------- APPLICATION I=ORtSANITATION PERMIT Permit No. . <br /> -------------- r s-- --- --------------------- (Complete in Duplicate) <br /> ----------------- ----- -•--- <br /> =-- This Permit Ex fres 1 Year From Date Issued Date Issued <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. <br /> v� +' ESCIgLON l <br /> JOB ADDRESS AND LOCATIOIQ_'-'------ESCA Lp -�r <br /> ----- - ------ D 2Do-_ ---- ---•-- ll��gH_�_ n[ <br /> - <br /> Owner's Name------------ ---•- .. -5THE� F-,---------�f <br /> Address 5.�---------e�,L p4 fi-VJF— <br /> --------------------- --------- SGS QAI_' -------•---------------•---------------•--- <br /> Contractor's Name----(9WIN K------------------ <br /> Phone ---------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commer.Cial ❑ Trailer 44urt [Motel ❑ Other ❑-'f <br /> Number of]iving units: �2- Number of bedrooms Y Number of 'oaths <br /> 'Lot size ------------------- <br /> ater Supply: ::Public systems❑ Community system Private Depth to Water Table <br /> Z ❑° P.. l 2 ft. ;emw- <br /> Character of soil to a depth of 3 fee4: Sand [] Gravel ❑T Sand 'Loam Clay Loam � # <br /> Y ❑ y �Cla�y.❑ Adobe El Hardpan � <br /> Previous Application Made:-(if yes,date------- No � New Construction: Yes [�so ❑ FHA/VA: Yes E] ',No <br /> TYPE OF INSTALLATION-AND SPECIFICATIONS: s <br /> rt t <br /> (No-sepfic,tank=.or cesspool-permitted,:ifrpublic.sewer.is;available-within-2004feet.)7 - ,41. � <br /> T <br /> Septic ink: Distance from nearest well------ Distance fro foundation._._�Q <br /> Material-�_'41u'CR-ET`s <br /> --- ------------•- 6� <br /> i No. of compartments.._--�-------------Size_�_X � --- --- -----Liquid depth__..7� <br /> ............-- Capacity--. 64!P..-- p0 <br /> Disposa field: Distance from nearest weft-..._`,j�--Q.--Distance from foundation-_--4/_0.-___---- <br /> Distance to nearest lot line__� <br /> Number of lines.--------_-/----------------------Length of each line----� - -------------.-Width of trench-----2y----�--------_---_ <br /> Type of filter materiai_-_ OC ,_- De th of-filter-material-___.-�� " g <br /> p - dotal length <br /> eepag rt:i Distance to nearest well_____ __________`Distance from foundation___ __ <br /> �0_...__-_-.Distance to nearest lot line--__S ._._._ <br /> Number of pits.-.__ —.-- --Lining material Diameter___ <br /> f .��. --------Depth-------.-.7.�_----- -------- N <br /> Cesspool: Distance from nearest well________________Distance from foundation--------__ <br /> 1 1 } Lining material --- <br /> ❑ Size: 'Diameter--- - Depth . <br /> I ------------------------------Liquid Capacity----------- gals. Q <br /> Privy: Distance from nearest well------------------------------------------- Disfance from nearest building 3 <br /> ❑ e � Distance to nearest lot fine---- <br /> Remodeling and/ort repairing (describe):----------------- <br /> -----------------------•-----------------------------------------• . <br /> ------------------ = !� <br /> ------------------------------'------------•-------------------------------------•---------•--------------------------------------------------------- ------------------------ a r <br /> ----- --------- ------------------------•------------------ ----- <br /> •--------•---------------------- -------------------------------------------------------------------------------------------------------------------------------- --------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County S <br /> ordinances, State laws, and rules and regula 'ons of the San Joaquin Local Health District. t� <br /> (Signed)- <br /> ----(Owner and/or Contractor) 3� <br /> ---`------ ----------------------------- -- --- _ � ,tf -------- <br /> t <br /> (Plot plan, showing size of lot; location of system in relation to wells, buildings, etc., can,be placed on reverse side). <br /> . IF <br /> { r FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED�BY-----_--F'-_R-D- <br /> ---------- -------------------------------- DATE---------- <br /> REVIEWED BY------------------ <br /> ' - <br /> ----- - = <br /> ED-- ------------------------------------------------------ <br /> - DATE ------ <br /> - --------------- <br /> BUILDING PERMIT ISSUED ------ -------------- --------------------- ------------------------------------------------- <br /> ---- - <br /> DATEf---------------------- - <br /> --------- <br /> Alterations and/or recommendations:--j-:1-f- -------7if}nfK---...V.,K.,_-____._______---____ <br /> ------- <br /> ? ­�- -'__.4Q--------f1_FHr.__j_1NF------TP------rt19NK 0,_K----------4FAc�,+. <br /> -------------- <br /> --------------------------------------- <br /> ----- <br /> ------------ -------- --- ---- - ----- -- ------ <br /> --------------- <br /> FINAL INSPECTION BY:.-_-_ . .--_---- - `> <br /> -- -------- ------- ---- ------- Date----- -- ----- ------------ <br /> ` SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. <br /> 300 West Oak Street 124 Sycamore Street <br /> 205 West 9t6 Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> F.P.co. <br /> A <br />