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FOR OFFICE USE: <br /> Ao - <br /> APPLICATION FOR SANITATION PERMIT Permit No. . .....- <br />- <br /> ------------------- - [Complete in Duplicate) <br /> l This Permit_Expires 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 Countyy Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION G7 ----•--------------------------------------- <br /> Owner's Name--------- V-17--- ew,*:-d4.7------------------ --------- --------------------- --------------- Phone------------------------------------ <br /> Address CT- ------------=---- <br /> -- -- ----------------------- <br /> ----------------- ---t-•- -------------------- ----------------------- <br /> Contractor's Name----------------- !' " � Tr - - ------ --------------------------•----------------•--- Phone----• .------••--•--------•------- <br /> Installation will serve: Residence❑ Apartment House ❑ Commercial ❑ ITrailer Court Motel ❑ Other ❑ <br /> Number of living units: __/--- Number of bedrooms Number of baths._.1--- Lot size,0-_`_0_-09-a---- <br /> �-------- <br /> Water Supply: Public system ❑ Community sysfem [] Private gq- 5epth to Water Table - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If'yes,date__..-------...::..: ) No 9?- New Construction: Yes —Jo ❑ FMA/VA: Yes ❑ No R <br /> TYPE OF INSTALLATION AND.SPEC FIFICATIONS:� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest we1l_-e-: wf_47 Qistance from foundat' n---� ------ <br /> No. of com artments', - Size_���__-,ZW i uid de th. _ -.� <br /> Disposal Field: Distance from nearest weft/�`- �_Distance from foundation---�C _��Distance to nearest lot line-_1_,:r <br /> Number of lines /%/)!�_, da-Length of each line_ , _ ./r ._Wed+h of trench_ �-- <br /> Type of filter material-�/eef�Depth of filter material_��F.----..Total length-��_�--------------------------- y <br /> Seepage Pit: Distance to nearest well.!....:.::.:.....:::..Dist ante from foundation------------------- Distance to nearest lot line--.____---------- <br /> ❑ Number of pits--- ------------ .-.-.L-.fining material---------------------- Size: Diameter--.--------------- ----Depfh--------------------------------- <br /> Cesspool: Distance from nearest well _--------------Distance from foundation------------------- -.Lining material---------.......____._------------_-- <br /> ❑ Size: Diameter- -- --------- -f--- ---------------.Depth----------------------------- - - ----------------Liquid Capacity----------------------------gals, g tl f <br /> Privy: Distance from nearest,well-____------------------------------------------Distarce from nearest'building..___-----------------__----_.-.---------- <br /> ❑ Distance to nearest lo. le - f ------ <br /> 16)(s <br /> y a <br /> Remodelin and/or repairing describe : 3_+1 .s' <br /> 9 / p 9 ly l } ! _ J7..�.�.�� .. � ��7---------- ----------------------------------------------- <br /> -------------------------------------- - i ._..---''-`------------------------------------ <br /> ------------------------------------------------- ---------- �_-----•-•--------------_----------------_----_---_--__-_-_----ew---- ---. <br /> - t -- ------------ --- - ----------------- <br /> 4 <br /> --------------- = " <br /> I hereby certify that I have:prepared this application and'that the work will be done in atcordance with San Joaquin County j <br /> ordinances, State laws, and rules and regulations of-the'San Joaquin Local Health District. <br /> - e <br /> [Signed]--- ------ •- -- -- --� -�--------- •'-- ---- <br /> ----------------------- - - ---- - --- ---(eWM==Vor Contractor] <br /> By:------------------------------------------ ---------- ----•---- --------------------- ---- ------- ----------------- . <br /> [Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., tan be-placed on reverse side]. <br /> -4 <br /> FOR DEPARTMENT USE ONLY 4 ' <br /> APPLICATION ACCEPTED f3Y---- ---�/��e -- - ------------- ---- ---------------------------- ----- <br /> DATE...... ----��---�---- --------------- ""n <br /> REVIEWED BY------ ------------------- --------------- •------- -- ---------------------- ----------------- DATE <br /> ----------------- <br /> BUILDING PERMIT ISSUED-------- -- ------ DATE---------------------------- <br /> Alterations and/or recommendations:------- -- ---- -- ------------------------ ------------------- -•----- ' <br /> ----------------------- ------------------------------------ ------------------------ ---- ----------------------------------------- --------------•------------------------------ <br /> - 0 <br /> ------------------------ --------_--- _--.-------------ti __-___-----.-------------------- <br /> s <br /> ----------------------- <br /> FINAL INSPECTION BY:..---G4/ ------- ----- ---------------- Date-------- .+ {7 - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160 1E.-Hazelton Ave. + i 300 West Oak Street .= 124 Sycamore Street 205 West 9th Street <br /> Slocklon,California Lodi, California i Manteca;California <br /> Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> r <br />