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' FOR OFFICE USE: " <br /> ............... !--------------------------------------- <br /> -------------­--- ....................... <br /> _.._- -__.______.-...._.._____.-___.._-------------- --------------------------- .. --------- APPLICATION, FOR SANITATION PERMIT Permit No. <br /> ------------- (Complete-in Duplicate) a <br /> Data Issued <br /> This Permit Expires 1 Year From 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 incompliance.with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION/lit:aATiH- .[ f WAY—� <br /> Owner's Name ---- } }_19U E'lQ R -- - ----------------------------------- Phone------------------------••---------- <br /> Address--------cls.. L ' = t4. p50N ----- 'T3`. <br /> Contractors Name-- OWA�K---------------------- --------------- = ------------ ------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House E] ;Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .____ Number of bedrooms�f Number of baths_ .. Lot size --------- -------- -_;FS----------------_------- <br /> Water <br /> --- <br /> Water Supply: Public system ❑ Community sys m ❑ Private �.epth to Water Table s- ft <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 6[�New Construction: Yes No ❑ FHA/VA: Yes [v]"'�No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: n �� <br />"F'-- -�(No septic tank if cesspool"permi+ted-if-public sewer is ava_ilable within 200 fee) <br /> Septic T Distance from nearest well_._-_...ti`?Q_Dista`nee from foundation -.__J�__.-.Materiai COAIC�'----------------------- <br /> No. <br /> €-....I G <br /> p - Liquid depthCapacity.-A==---- ----- ( <br /> No. of,com artments._._____� __.....Biz ___ __ __ _ _____ �z-:_..___ • 8 �. <br /> Disposal Field: Numaberofol lines <br /> w 11--- = "�istan of ch IJn3 atio _-- ,..__._.Distance to nearest I� line_,_____-___.-__ ! <br /> p ;� <br /> ---------- g -_Width of trench.----- � � ---------L <br /> Type of filter mate ria l.__13_0C#_1----Depth of fi1tteer materiaL___..__� .-"___Total length__-_----/2n .'_--__- <br /> Seepage Pit: Distance to nearest well--------.--- Distance from fbundation-------____'-------Distance to nearest lot line_________________ �. <br /> ❑ Number of pits---------------------Lining material.- °-,,Size: Diameter-----------------.----Depth--------------------------------- <br /> J <br /> Cesspool: Distance from nearest wel! -----------_.___Distance from foundation_ Lining material__._.._..._.___________ _____-.._-. <br /> ❑ Size: Diameter- -- --------- ----- ----------------Depth`'_ - .............. �------------------Liquid Capacity-.--.----------------- gals. a <br /> Privy: Distance from nearest well.................................................Distance from nearest building----- <br /> -------------------_----_____-. .. . <br /> ❑ Distance to nearest lot line ------------------------------ --- --- - - <br /> Remodeling and/or repairing (describe)----------------51Y,6T€r ------- <br /> -------------- <br /> ----- ��fl--_- r � fJ �-----f O ._..I J -----elf l_Y ----- -•: <br /> gA_I:st3f6_ �----- ---------------- <br /> --------------------------------------------------------------- ----------------------------- <br /> - _ - <br /> ----------------------- ------ - <br /> ------------------------------ <br /> I hereby er+ify tha I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances tate laws, nd rul s and regulations of the San Joaquin Local Health District. <br /> (Signed)---- r� v"�J ��---_---------------•--------------------- (Owner and/or Contractor) <br /> -------...---------------------------------------------------------._. �: :. _r =--" - )--'-- �--- - "------------ -----= -- =� <br /> (Tide _. <br /> (Plo plan, showing size of lot, location of system in relation +o wells, buildings, etc., can be placed on reverse side). i <br /> FOR D- ARTMENT USE ONLY <br /> r� <br /> APPLICATION ACCEPTED BY E -' -------� <br /> ` --- '`�-J-' <br /> --- ------------------------------------- DATE-- 5� -74/ <br /> REVIEWEDBY-------------- ------------------- --------- ._---------------- -------- ---------------------------- ----- DATE------ ----------•-------------- <br /> BUILDING PERMIT ISSUED - - -- --------- DATE---------------------- <br /> Alterations and/or recommendations:........--------- ------------": --------------------- --------- ----------- - <br /> ------------ ----------- ----------- -----------------------•---- ---•-- -------------------------------•---•----------------- -------•------------------------------ ---- <br /> --"----------------------- --- --------- - - ----- ---------------------------------------------------------------------- --------------- -------------------•------- <br /> F1NAL INS TION BY Date----------- <br /> ._. ..- <br /> _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT-:'. <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street <br /> Stockton,California Lodi,California Manteca, California ' Tracy, California <br /> -� E.H.9 2M 1.47 Vanguard Press <br />