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i r�1Z OFECE USE: <br /> _--------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. .__fP-_ ---- <br /> ----------------'---- <br />----------- "' (Complete in Duplicate) <br /> ----- --- -- ----- � Date issued __�_�:"E°_..f?� <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to he San Joaquin Local Health District for a permit;to construct and install the work herein described. <br /> This applica i s made i compliance with County Ordinance No. 549. S�ty� <br /> } <br /> � FNO -------- AY- ---- <br /> oOwner ' I � i <br /> r's Name------- ----.-'---- <br /> AVE <br /> Address----------- .--,------U14L1- -MOD- - <br /> Contractor's Name <br /> M- 4fEN,1�4 VPZ57Qone- ------•-----------------••---- <br /> Installation will serve: ;Residence Apartment House ❑ Commercial ❑ Trader Court ❑ Motel*Ej .,Other ❑ <br /> Number of baths'_. Lot size _:____. _� - <br /> ' th t % j- - -x ------------ <br /> Number of living.uni+s: -! ----- Number of bedrooms _ -- N P� <br /> Water Supply: Public system — Community system ❑ Private �/bep 'ter Tablet%-- ft. 0 -9 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam I'ay Loam ❑ Clay ❑1 dobe ❑ Hardp <br /> Previous Application Made: (If yes,date---.-;--------------) No New CO .21-Nonstructl0 Yes , No E] F A/VA: Yes No El <br /> TYPE.OF INSTALLATION AND SPECIFICATIONS: ,Y i .'�T _, , _ _ _ ; <br /> (Na septic tank or cesspool permi#ed if pubic sewer is avertable wtthtn 200 feet.) <br /> ._ i <br /> /� It eriaSeptic T Distance from nearest well___-_-_-___Dista a from foundation__No. of compartments-._.�---- ---------Size_ �2x__J�_____Liqu�ic depth--- �.. -`___ - Capacity.._----- <br /> p <br /> C1--- <br /> Disposal Field: Distance from nearesti well---✓�_Z7.-'Distance from foundation i-O.__._.-Distance to nearest lot line _ ____�� <br /> Number of lines__I__------- -------------- g (lined_ ` ' Width of tre ch <br /> Len th r-of each. <br /> Ty- e.of filter material__-_R().e �- Depth of: filter maFenal=_ � �� Total.�length__ <br /> / - IRAM <br /> $�aoe PI �rstaflo est w stance from foun _- t nce to neavesitst=Trr�e <br /> �.. <br /> m er o pi s__:. _--Lining maternal_ . Q- Size: Diameter_ :X Depth's ____ <br /> Cesspool: Distance fromi'nearest well-- ---------Distance from foundation___. --------------Lining material-_ __________ __________ _ ___.__ <br /> ❑ Size: Diameter:---------�---- �Repth �+ffi. Liquid Capacity 9als;`x <br /> Privy: Distance from nearest well�i _� ; tR ---- - - ----- Distance from nearest building ______.__ -_ ----:- . <br /> ----- <br /> Distance-to nee est lot line -------------- � --:----------- - �------------- ----------------------------------------- -=-=`--"''��-- � � I <br /> ff Q I P �I 's 0_ IC' A I"'^w--------------�� !"3"------------ <br /> 11 <br /> �l"� <br /> Remodeling and/or repairing (describe}: ---____. ___ __ <br /> ---------------------­----------•----- -------#--- --------------­---------------------------!S1 �" ? ` , ► �#'I�+d I` 1 F "`----- ------------ ------- ---- <br /> R - c'T- -------- -------------�-----S .U�--QF K �4�TA���--T�.�Q- <br /> wb - ----------------------------------------------------------------------------- --------- <br /> -------------------- --------------------------------------- <br /> I hereb ate! have prepared-this-appIication-and*+hat-the,�w4k will be done in accordance with San Joaquin County <br /> ordinance +a+e la 1, and ru s a d regulations a San Joaquin Local Heait strict. <br /> (Signed) <br /> ------ - -------- ,_(Owner and/or Contractor) <br /> --- ......... <br /> _. :. _=- -`. �� == ----- .. ::= _ <br /> (Plot plan, showing size of lot, location of system'in relation to wells,-buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----------1= 0o z f ----------- <br /> --- ------ -------------------------------------- - DATE-------- -•---- �-�---�-�-� I <br /> REVIEWEDBY--- •----- ------- ~b._5`__ ... -- -- ---- ---------- DATE------------------------------- <br /> BUILDING-PERMIT-ISSUED,-----------;.4,--Ac_I-....... 14_z�-�D }S SNQ�n(r ,,RDATE --- --------- <br /> .. r '` rcl1t'7. v Ir ti kti� Y <br /> _11f ccr Alf�Qc1 SILL"t-NTrpn�S � ...... _ - <br /> VA a., ---------- <br /> = ------ ------ --------------- ------------------------- ------------ -------•--------------------------------------------------------- <br /> - ---------- ------------------------------ ------- -- --- --------------------------------------------------- <br /> i <br /> FINAL INSPECTIO - Date -- <br /> r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> slocklon,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 3M 3-'83 F.P.CD. <br />