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FOR OFFICE USE: <br /> --------------------------------------- � Permit No. <br /> -----------.. <br /> _________ APPLICATION-FOR SANITATION PERMIT- / <br /> ------ (Complete in Duplicate) , / <br /> - --- i�� 1&16VD.+e Issued -------.��./...(o <br /> ----------- This Permit Expires 1 Year From 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 /> JOB ADDRESS %ND LOCATION- ----- _IAM -------A- ... PN5../ .---�� - R�®4`M_ •-•---------- <br /> Owner's Name-. - -- H-1_,i3l;;-��1 J�I�---- -- Phone--------------------------------- <br /> Address-----•----•-------. - ® 1 <="�" ` -------------•-----I........................................................ <br /> Contractor�s,�rName = t _ -- ----- - --- -•---------------- -� ...-,»P.hone- •---------- <br /> ,/'Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-E] <br /> �. -- � - - ------L�___ -PC--------- <br /> Water Supply: PuNumber of blic system ❑ y y ❑ 01" p <br /> living --- ,,ryry <br /> ( Communit lest mms Priva}e Number Debthhto WateroTable 1 . ft. <br /> dl: <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ S,anAy. Loam ❑ Clay Loam ❑ Q lay ❑ ,Adobe❑ Hardp.n ❑ <br /> , �� <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes L Nv if ❑ FHA/VA: Yes 7o ❑ <br /> No septic tank or cessND SPECIFICATIONS. <br /> TYPE, F INSTALLATION A _• _ <br /> Se tic T Distance fpool permitted�If pubhcsewer is available withrn200-feet,) f P �� <br /> ( P <br /> p rom nearest well-----------------Distan from foundation M ter' I____C01-4CRE.T—�,_.�. <br /> - .rte <br /> No. of compartments__ -a Seize } �®_ JrLiquid depth _ I��- ._. ._ Capacity_�i�© <br /> ��_•.V� � ' ; <br /> Disposal F'"Id: Distance from nearest well `✓' ''Distance from foundation. _/ .Distance to nearest lot line- N <br /> ^ ��` ..Width of trench 6 � - { <br /> Number of lines__ 3� _ _Length of each line e <br /> T Typevf filter material.. /�1!_Depth...of filter�mate.rial �� . Tota'I length� � <br /> Seepage Pit: Distance to nearest well _-- _ - _Distance from foundation____________________Distlance''to nearest lot line____. .______._ <br /> ❑ N tuber of pits__ !-_ -. g tSize: Diameter - k4`�`._ ..__Depth .....__-- <br /> � 11 <br /> - -- -- Linin material----- ----_- --------- >`�r-►� - --------•--------(-�r0 <br /> s=t <br /> Cesspool: Dilta Tce (from nearest well----------------f Distance from foundation '--Lin tlrig material--------------_----------------------- <br /> El <br /> ______ __ ________ 1 <br /> Sizle:�D meter--- 1.- ----- Depth ----- -- -------- - -------=`�- -Liquid Capacity ----------- ----gals. <br /> Distance `from nearet ell * _Distanfrom sneare(Sf�building----------------------- <br /> Privy: <br /> , ., - <br /> ❑ Distance to nearest lotaine -- ----- �- <br /> Remodeling and/or reairing (describe):_ <br /> — y <br /> ------------------ --------- - { I---II----------- '4-4-1-A-�- ---- ----------------------------------------------IC ----- -------- --- ---- - <br /> ------------ -- ------------------------ -- NK--------- ------------------------------------------- ------- - -- <br /> --------------------- ----------- g-,----------------------- --------- ------------------------------------------------- ---------------------------------------------------- <br /> I hereby certify the* I have prepared +his application;and thai'the work will be done in accordance with San Joaquin County <br /> ordinances, States, and rules and"regulations of the Sari Joaquin"Local Health.Dist rict.. <br /> I . <br /> (Signed)..-----Z_e k ------------------------------------------ ------.(Owner and/or Contractor) <br /> f � - � --- �I dC <br /> BY --__-•� ---------- �.�`..."-` ,(Title)-_1 --- _- . <br /> (Plot plan, showing size of lot, location of system'inlreilafion)lto•wells,.buildings;etc—can*be'•pla ff own reverse side). <br /> r <br /> A `�,-FOR'DEPARTMENT USE-ONLY <br /> APPLICATION ACCEPTED BY----------- q._r-�-•-o_ -- �-- - <br /> `!� DATEf - <br /> REVIEWEDBY -------------7'-"-----=------------------------- -------------------------------------- ---:- DATE-- ---------- <br /> BUILDING PERMIT ISSUED ,"'...-W ..._ DATE: �G <br /> Alterations and/or recommenrdat ons 6_ . - 1� Fa_ -T_'�.N lam____. -I L- -_D.... <br /> ---• --...._° — -� -- 4d 0.---------- �- ---' Y-------------- ---- -------------- ---------------------------------------------------------------­------------- <br /> ....... moi►-f. `°-sr=rv� c ��,vsr,9s .S°H� 9G ------------------------------------------------ <br /> 1-::_/ <br /> - t . <br /> FINAL INSPECTION BY:.---------- ------ ---- Date /�`� �! Qt{ ?3 - if t <br /> SAN JO QU N LOCAL HEALTH DISTRICT 1►v s�F'�-�-f o� <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 /> ES 9 REVISED 8-59 3M 3-'63 F.P.CD. ��' <br />