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f 1 FOR;, )FFICE USE: <br /> ------------------- --$--------------------------------- <br /> - APPLICATION FOR SANITATION PERMIT Permit No. ..._... ...:._. .. <br /> --------------------------- ------- --- ---------------- (Complete in Duplicate) 7/rG! �. <br /> This Permit Expires 1 Year Fromvl,Date Issued Da Issued ____________ ___ <br /> _� �s,....�a.rr-mow,. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and infall-fhe work herein described. <br /> This application is made in compliance with County Ordina <br /> lice No. 549, A4 T-C-A^ <br /> JOB ADDRESS'A D LOCATION '_:= ------- rF_ ... t!1Li . <br /> - <br /> Owner's Name. L.? _ , ��p �'Li �N -._.f�I-17-F�`"-S10 t"-A Phone <br /> Address------------- �_ _ _> L_T---- � ---------------------------------------------- ' <br /> i AVA <br /> Contractor's Name / A _[ ? _f-nc ----- --------------------------------•----_- Phone--------- -------­----------­- <br /> Installation <br /> hone----•---.....---•---..---•--<---•-- <br /> Installation will serve: Residence Apartment House I] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Nurriber of {icing• units: __ ____. Number of bedrooms -Number of baths _�____ Lot size _______ ______-_______-______ <br /> x4 ,,�/ <br /> Water Supply: Public-system ❑ Community system ❑ Private Depth to Water-Table _llft.Cie - r-�-� <br /> 10, <br /> Character of soil*to a de. th of 3 feet: Sand ( `,vel ❑ SandY Loam Clay Loam El ❑ Adobe ❑ Hardpan ❑ <br /> i . <br /> Previous Application Made: {lf yes,idate-------------_.___-) No M-`�New Construction: Yes ®'No ❑ FHA/VA: Yes ❑ Nodi] <br /> TYPE---OF INSTALLATION AND SPECIFICATIONS: r- <br /> w (No septic 'tank�or cesspool permitted if public sewer is available within 200 feet.) <br /> c � r <br /> Septic Tank: Di.sfance from nearest well-_-5 ____-Distance from.j oundation___-A�___- Material l o --------- <br /> Noof com artments_ 'Sizex_ _ Li uld`de thS7L-� <br /> © P --- ----- - - -- - - - q � P. -- --"�,.-----CapacitY-����-------r Q'y <br /> Disposal Field: Distance from nearest well.-----5 Distance from foundation____ _C'_____-Distance to nearest lot line--.,4.> --- <br /> Number of lines------_------ ___Length of each line________ -Q f Width of trench...-_�-L_ -" <br /> 11114 <br /> Type of filter material-__. AJC __Depth.'off filter material____---/ ------;Tbtal length_____________________ Q---------_" <br /> Seepage Pit: Distance to nearest well _______________Distance from foundation________________j.Distance to nearest lot line______- ___-_- <br /> Number of its'._ __Linin maferial=_______- ___- - <br /> ❑ p` g ...� 5izJDiameter------------------- ---Depth-- -----------------" <br /> Cesspool: Distance f;om nearest well_________________Distance from foundation------ Lining aterial_______.-__-_-_.___.______--____-__i <br /> ❑ Size: Diameter -- ------------------------------Depth------------------------------------------- - Liquid Capacity----------;------ ---------gals! <br /> Priv Distance from nearest well------ - -------------------------------------Distance from nest builclin -_ -----_--_-__ <br /> ❑ Distance to nearest lot line--------------------------x - (h <br /> Remodeling and/or repairing (describe):--------- } / ------ /__f. -/ �,= :S> C'_----- � <br /> --------------------------------------------------=----------------------------------------------•---------------------------------------------------------•---------------------------------------------------- <br /> { <br /> ----------------------------------------------------`--------------------------------------------------------- ------.------------------------ ----------- <br /> I hereby certify that I have prepared this application and that the work will be done;in'accordance-withTSen Joaquin County <br /> ordinances, SfafWlawsj and rules anis r gulations of the San Joaquin Loc" <br /> a{ Health District. <br /> *fl � �- ----------------•- <br /> _.-.(Signed),-----------------•------------�.-----=-----�--•� --- - - - ------=------- ---Title------ -----_-----{Owner.and/or�.Gontractor.].„�,:...._ <br /> Y:---- --------------- ----- ------ ---------- { ] <br /> {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be,placed on reversesit{e].,, �„ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- •-f-> 1�1=Q. DATE <br /> REVIEWEDBY-----------------------------------------------------------------=------------- ----------- --------------------------------- DATE----- ------- ---------------------------------------------- <br /> BUILDINGrPERMIT�iSSU:ED:_ _ � ,DATE <br /> _ ------ <br /> -------------- <br /> Alterations <br /> -------- ---- <br /> - <br /> Alterations and/or recommendations-----------------------------2i------------------------------ ----_--------------------- -------------------------- <br /> --- --------- yZ-. ^ (c � 'i'li�,t.- .-. __ brrEP �`r TIN . T! i <br /> -------------------------------------------------------•- ----•-------------------- { <br /> t <br /> •----------------------------------- ------------ --- - - --- ------------------------------------------ ------------------ <br /> ------------------------------------ ---- --- <br /> FINAL INSPEC710iY. p — Date----------- ���'"�' ----- ------ --- - ti <br /> �h' d = <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT, -- <br /> 1601 E.kaieltan Ave. 300 West Clak'Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California a <br /> ES 9 REVISED B-59 3M 3-'63 F.P.CD. , <br />