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FOR OFFICE USE: <br /> APPLICATION AOR SANITATION PERMIT Permit No.--------------------------- <br /> �-...-.-�� r <br /> -..------------ ----- --------------- (Complete-in Duplicate) J/ <br /> ........................ ...........__._______._......... This Permit Expires 1 Year,From Date Issued <br /> Date Issued .7 -- a__----� <br /> Application is hereby made to the San Joaquin Local Health Dist it ctjfor a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549, 2 &0 3a <br /> Y--bao o- fZ.0 <br /> B ADDRESS AND LOCATION---- -- -----�A J ��`�tz'r7-.- �lG2 ' <br /> J <br /> Owner's Name------- 4' ' � Phone... �.' -?-S-- <br /> Address----------------------------f = f :- � y1.r ----------- ---------------------- } <br /> Contractors Name ,-- ,...-._ ..Gt �' �--- < � Phone-7.�r�.t! -� <br /> i <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ *� <br /> Number of living units: .. ..... Number of bedrobms'".`_'Number of baths-------- Lot size ----- --- -------- -------- -------------------------------- <br /> Water Supply: PublicVystem ❑ Community'system ❑ Private Depth to Water Table ...�_ ft <br /> Y k � <br /> Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_..-__--- ) No`` z New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ , <br /> a .' a <br />. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: � � �, '. •_ <br /> (No septic tank or cesspool permittedif public sewer Ts available within 240 feet.)' ° <br /> p No. of compartments-___1�------�'-.��Size--- 5 -- --. - 9�'��f--->;Material -------------------------------------------- <br /> No. <br /> - ----- � r <br /> Ca acit _ � Q <br /> Se tic Tank: Distance from nearest well-:-** <br /> Dista�eK�jf�ou�n�at-on-uld depth` 1�� p y <br /> j t # "c Q <br /> Disposal Field: Distance from nearest well.'0Q.......Distance from fo,undation..._ _ €..-----Distance to nearest lot line------------------- <br /> Number <br /> .._..____.'.- � <br /> YP I--------------------Length of each line_- ----- --:`--...Width of trench....` ----- --------- <br /> Type <br /> f`l <br /> 7 e of filter material._ f ---------- <br /> Number of lines------------- <br /> -�OC1�----Depth of filter material•''--���-1-r- -----Total length-------------------✓�..0--------------e--- • <br /> Seepage Pit: Distance to nearest well__-� �---------,Distance�f om oundation..._� ..-----Distance to nearest lot line----------------- <br /> Nu <br /> ...._____-.__- <br /> Number of pJs_._ I--------.-_.'-Lining material.}l+ ..... � ��."'.----- Depth-----:�� `----°:- -- <br /> . Size: Diameter_.--. <br /> ! i <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....-.-.-.. ... . Lining material..._.-----------_._...------.-- <br /> Privy: Distance fromrnearest well-- - -Depth-.-{---------�4��Jistanee�fro -----Liquid CapacitY----------------------------gals. <br /> ❑ <br /> ❑ �. # <br /> nearest building.----------- --------------------------- <br /> Distance <br /> -------------------------Distance to nearest lot line: f. '` t ----------- - ---M----------------------------------------------------- <br /> Remodeling <br /> -------------------------------------------- - -Remodeling and/or repairing (describe -------- <br /> ------------------------- "------------------ .,------'----------==- ----!_-- <br /> ----------------------------------------------------- <br /> ---------------------------------------- ----------------- --------------------- --------------------------- -------- --- ---------- -------------------------------------- <br /> ------------------ °--------------------------------------. ..-------------------- <br /> -- -- ----------------- -------------- <br /> .------_-------------------------------- ---------------------------------------_.__......_..-__....._.-.._-..-.--.-.-..._i......_------------- <br /> I hereby certify that I have prepared this application and that the work'will'be 'done in 'accordance with San liJoaquin County } <br /> ordinances, State ws, and rules nd regulations of the San Joaquin Local"Health District. <br /> j • '`'r <br /> (Signed)------ ---- (- / C� ----- - -- ---j- ..- ...- ry -,-- Owner and/or Contractor) I <br /> Y ` ------------------------------- <br /> (Plot <br /> ----- - <br /> (Plot plan, showing size of lot, loc of system n`relafrion to wells, buildings, etc., can bye placed on reverse side). <br /> r <br /> l FO'R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y---�[_.�-_tom`--------- ----------- _----•-#------ -----�------DATE- 5 ---------------------------- <br /> REVIEWED <br /> t <br /> _ ._-- - _ "'=-- --""- DATE.....-.---- MMM-M- <br /> REVIEWED BY-------- -- {---- - - ----- t .. _ ,�; ..t��. �_ _� <br /> BUILDING PERMIT ISSUED------- - ---------------------- -------------- -------------- --: ------------. DATE.--------- --------------------- "------------ <br /> Alterations and/or recommendations: 11----------------- --------- ----------- <br /> ---------------------------------- <br /> --- --- ----------- ----------- -------------- - ------------ ----•----�------- ----------------- -------------•---------- <br /> ._..8 .....------------.........�.--------..._------..---- <br /> M <br /> .................... .......-................ ...... ._ .-......_._..-`- ..._._ . . ------------ _.._.--------------...-------................----------. -------.-__.--..--.......... <br /> FINAL INSPE //%// Date............... ..4 <br /> "'""SAN'JOAQUIN LOCAL'HEALTH DISTRICT`' <br /> r <br /> 1601 E.Maielton Ave. 300 West Oak Streel 124 Sycamore Street 205 West 9th Street I <br /> I <br /> 519ckton,California lodi, California Manteca,California Tracy,California -, <br /> E.H.9 2M 1.67 Vanguard Press -- � <br />