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FOR OFFICE U.: - <br />APPLICATION FOR SANITATION PERMIT Permit No.'.64-F <br />-------------- ---------------- ---------------------- <br />Ai (Complete in Duplicate) Date Issued <br />-------------- ----- -------------------------- __ - -1 . This Permit Expires 1 Year From Date Issued <br />Application is hereby made to the San Joaquin Local Heal h District for rmitt to construct a i9stall the work herein described. <br />This application is made in compliahce with County 7rtq U6 0-' <br />349 <br />VOW <br />. 1 '010 <br />JOB ADDRESS AND r7 . ........... "Ov�rwe� d!�, <br />---------- * ------ -- ----------- ---------- I -- -------- -------------- --------------------- 4K - <br />Owner's Name ------- ------- .�#I.ff ------------ ----- -- --------------------------------------------- Phone ------------------------------------ <br />- �� 1# IC <br />Address ------- /ycz......a.7-1----4,,. ------- ; -------- --------- ------------------------------------ <br />Contractor's Name..--. -------------------------- ----- ------- - -------------------------------------------- PhoneP --- - ---------------- <br />Installation will serve: Residence [�rApartment House E] Commercial E] Trailer Court L] Motel [] Other ❑ <br />Number of living units: Number of bedrooms qg ... Number of baths. _/--- Lot size -j--Of Cfe s a._. -__:-- <br />-------------- <br />Water Supply: Public system E3 ❑Community system E] Private 2q""Depth to Wafer Table/ - ft <br />Character of soil to a depth. of 3 feet- Sand [+Grave; [] Sandy Loam F] Clay Loam Ej Clay E] Adobe [] Hardpan C] <br />Previous Application Made: (If yes il date--- No 9?"" New Construction. Yes 0 E] FHA/VA; Yes ❑ No El <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />_.(19c� septic�-,fankor,,cesspppl-p:er.mi.f.ted-� <br />-r ee <br />Q AF <br />Septic Tank: Distance from nearest well-4?40 ------- Distance from joundafion_.-/40 ......... IC <br />No. of compa4men1s_....Z ----------------- Size -!?!.X. ----------- <br />----------- Liquid depjh__4!�Pi. .. ........ Capacitylla <br />Disposal Field: Distance from nearest wel)_6_5". -.-Distance from foundatiorka-r-_ Oiitalnce to nearest lot line-YX ----- <br />Number of 66't ........ A ---------------------- Length of each line-1,O--r------------.Width of frenchcn?_Y_`** ----------------- M5 <br />or10 t- <br />Ty,pe of filter n�ateriaLQWor4_011C&_Depfh of filter maferial___/_47_'* ----------- Tofal length --- ---------------------------- <br />Seepage Pit: Disfanre to nearesf well ........ --- Distance from foundation -------------------.Distance -------------------- Dist�nce to nearest lot line ----------------- <br />❑Number of pitsl --- - ------- ------- Lining material --------- ----- Size- Diameter -------- Depth .......... --------------- r ------- <br />---------- <br />Cesspool: Distance from nearest well ----------------Distance from foundation- Lining material-_-...------------------.-----------. <br />El <br />Size: Diameterl -- --------- ----- ---- Depth -------------------------------- : -------------------- Liquid Capacity ---------------------------- gals, <br />--Privy-:-- Distance from I nearest well ------------------- -------.-___..______________Distance from nearest I buiicling ------------------------------------- <br />❑ Distance to nearest -lot line . ----b--------------------------- - � <br />Remodel <br />-- ----------------------------- <br />Remodel ng and/or repairing (describe):__._ -- W - ----- --------------------------------- -------- ----------------- --------------------------- - <br />---------------------------------------------------------- - 11 <br />---------- ----- ------ ------------------------------------------------------------- ----------- I --------- ------------------------- --------------- ---- <br />---------------------------------------------------- --------•- ------------------------------------------------------------------------------------------------- ------------------------------ ---------------------------- <br />--- ---------------------------------------------------------------- - ------- --------------------------------------------------------------------------------------------------------------------------- --------------- <br />1� <br />I hereby certify that 'l have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules aiid regulations of the San Joaquin Local Health District. <br />(Signed) <br />---------------- --- .............. ...... JG�encl/or Contractor) <br />----------------------- - <br />---------- _ - �__ ---16 <br />By:— -iPp=E <br />(Plot plan, showing size of lot, location of i"y7ske—Z <br />m in relation f <br />.4 <br />--- ----------------- --------- --------- ------ --------- <br />wells, buildings, etc., can be placed an reverse side). <br />PARTMENT USE ONLY <br />APPLICATION ACCEPTED BY-- -------- ................... ------------------------ ------------------- DA <br />REVIEWED BY 1M DA <br />BUILDING PERMIT ISSUED <br />------------------------------------------------------------------------- - - --------- DATt <br />Alterations and/or recommendations:----------------.---------------- - ------ - --- ----------- - ----- x -1111" <br />---------------------- ­- -­------------------------ <br />--------------------- L <br />------------------------------------------ I --- <br />---------- --------- -- -------------------- ----------------------- ------ --- ------ ------ <br />/r ----- L ----- ---------------- -------- ------- ------- -------------------- ------ <br />---------- ------- ------ ---------------------------------- ----------------------------------- L - - - - - - - - - - - - - - L - - - - - - - - - - - - - — - - - - - - - - - - - - - - <br />--------------­ ----------------- ------------------------------------------- <br />--------------------------------------- ---------------- - --------- --- ---- : ........ ------- ---------- -- --------------------------------- <br />. . . . . . . . . . _ - - - - - - - . . . - - - - - - - - - - - - - - - - . . . . ­ - - - - - - - - - - - - - - - - - - - - - ---------------- <br />------------------------- <br />. . ........ <br />FINAL INSPEC Date.. ......... <br />1601 E. Waxelton Ave. <br />Stockton, California <br />E.H. 9 2M 1 •67 vanguard Press <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 124 Sycamore Street <br />Lodi, California <br />Manteca, California <br />2Q5 West 9th Street <br />Tracy, California <br />