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.._._ __._.______________ --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ':��_ ' <br />---------------------------------------------------••-- (Complete in Duplicate) <br /> ----------------------------------------- - This Permit Expires 1 Year From Date Issued Date Issued ------ <br /> Application is hereby made to the San Joaquin Local Health District for armit to constru and in all the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ,hl 1210- 1 p SE W O CKVlsZ.Hj <br /> - �` C rye.?o1�f <br /> JOB ADDRESS AND LOCATION.../W ------ARO---`-••------- <br /> dor w•� p ! <br /> Owner's Name------d [?._TATER--•------------------------------------•-----. -� ..._ [F—�?!,7y <br /> - ---•---� ----....__ Phone. ..--- -;, <br /> Address--,........... . ------•----------•------------------ ----------­--------- .;.....----------•••-----•-•--•--•••-...-••---••-•-•............-•-- <br /> ,:wr <br /> Contractor's Name....... !Y_F ............. ..................--------------••----•---------..-.......----•------,-----••----.-•--- Phone............................I...... : <br /> Il <br /> Installation will serve: Residence &'Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - <br /> Number of living uni+s:l______ Number of bedrooms_. Number of baths_.?Lofstzel.____._ _-.';g -:....A�8�............... <br /> Water Supply; Public system ❑ Community syste ❑ Private �ep+h to Water¢Tab'le e��. <br /> fi • <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay LoaK[jl Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made t If es,date_-_____.__._ l No New Construction:PP WI n: Yes No C] FHA/VA: Yes ❑ No 94--`TYPE.OF INSTALLATION AND SPECIFICATIONS: <br />_ ti ' toacesspool.permitted, <br /> -public- at ? of <br /> ao _SepticT nk. Distance nearest well -„ 6 f ..Mat ree �_. <br /> . <br /> ` No. of compartments--------��, _________Sizet _ _ ______ _______.-Liquid de th'_.. ------------------Capacity d;7_.1. <br /> Disposal Field Distance from nearest Well___Sff ..._Distance from foundation•-! ------------Distance to nearest lot I'tne� ._.Is........ <br /> Number of lines----------/---------------------Length of each line...... �r....Width of french-----.Z,f........................ <br /> Type of filter material---A94A-----Depth of filter material..__, -___-_--Total length_......._ .............. .... <br /> Seepage Pit: Distance to nearesf ells",. fi 'Distance'fr6mn foundation_ !77Vstance to nearest lot line__.___-f_ <br /> Number bf pits........ ------------Lining maferial__139;�-----Size: Diameter_,-.- 3._._.._.:Depth------/2..-------•----------- <br /> Cesspool: Distance from no <br /> arasf well_________________Distance from foundation....----------------Lining material________------_.___.._______•--.----- <br /> ❑ Size: Diameteri s Depth t. _ Distancrom , quld CapacltY --•-gals. <br /> ----------- ------ --Li <br /> Priv Distance-,from nearest well_____:__________ ___ __ _ 'nearest building._.________________---..._.______________- t <br /> Distance fo nearest lot line------ _ ��#-- �..-_,, f <br /> r . <br /> fi ............................................. <br /> Remodeling and/or repairing (describe):---__.______' .._d.�.� _--�._.....s----- __ (� <br /> --•••-•-••------•------------------------------------------------------------------------------------------------------------•-----!--•-----•--•--•--------•----------•-----------------•----------------.-------- <br /> -*. _'-) 1-j------------•-------------------- ..................... <br /> --------------------- --- - --------------------------• -------------------------------------------4..-- ------------------------------------•---------------- <br /> I hereby certify that lihatpred-+his,application-and�-that the-work-will,be,done h—accordance with San Joaquin County <br /> ordinance�. Sfafe laws a%ge gulations of the San Joaquin Local Health,District. <br /> lk <br /> (Signed).: ------- ---- ---------m----- ----------------------------- -- ------ - ---------------.._...------------._.Owner and/or Contractor <br />�.�.- ABY- = _- _• ----------- {Title)------ ---- - - _ ------ --- ----- ,. - <br /> {Plot plan, s owing size cif lotjocation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY I <br /> APPLICATION ACCEPTED BY.._-.. ._ ,.____ � <br /> �` t-------------------- --------- -- ----------------•--•--------- .DATE.. (r <br /> REVIEWED BY - `�! -_ ------ DATE <br /> -- ;- = ------------ --------------------------- <br /> BUILDING PERMIT ISSUED...616T�L-- _._ DATE------------------------------------- --------------------- <br /> Alterations and/or recommendstions:--_ .i Y1l04'T- __RN :JN�_r���T�Q�[ <br /> i4i D_'�.” . o " .131---2) _ --. A►.7`.-----------. ... .&VF00tt&7._AR_i.Nf�D.---- <br /> 1► . ..__-� R fni- _T t� `f r_..- y FM R ::� r.� &�_,------------------------ <br /> ----•-- ------------------------------- --- <br /> _..__.. f.;. -� �' - -•------ -------------_----.----------------- --------------•-------...._.._. <br /> ............................... <br /> El) <br /> FINAL.INSP.ECTION-$Y-41 + Date---------�� •��---�"..-...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak S reet 124 Sycamore Street 205 West 9th Street <br /> Stockton#Collfornia Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.99 aM 5-6t ATLAS <br /> Rr �i <br />