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r , +FQR.OFFICE USE: �� <br /> I/� 7,/ <br /> -------------- <br /> -------------------------- ff - <br /> A PLICATION FOR SANITATION PERMIT <br /> Permit No. .lP.. .-. �� <br /> ------------- ------------------------------- --------- (Complete-in Duplicate) $� <br />- 1:�. <br /> _.____.__-___-_______._____-_______._____.--- This Permit Expires 1 Year From Date Issued 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 /> t, This application is made in compliance with County Ordinance No. 549. <br /> • A _ <br /> r. JOB ADDRESS AND LOCATION....- T----= -------- J. .l'P- T-------�`-�1_�------------------------ -Yf-......................... <br /> Owner's Name �01).------...Ix �_.O-A...`---- ------- ----- -- -------------- - ----- - ------ Phone � ............... <br /> . <br /> Address...........................1.27--7 ' ----------------------_-61 ( f'ti---(------------ ---------------------------------------- -- ........................................... <br /> Contractor's Name_bii.tvi[ z----------------------------_---------------------•------ ------- -----------------------•--•-------------.-----. Phone---------------------------------- <br /> Installation will serve: Residence E]-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �,� ���� <br /> Number of living units: _. .P._ Number of bedrooms _-�__ Number of baths.-:_ Lot size -----I�_3___�_------3-.----___________________ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _ ft <br /> dFCRy SAND <br /> Character of soil to a depth of 3 feet Sand G;ravel ❑ Sandy.Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) Nom New Construction: Yes 0--lgo ❑ FHA/VA: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well....5. .....Distance from foundation-----�C'---- _.Material �L�/fid � _ T" ----------- <br /> No. of compartments---------? Size_. r��----V_ _Liquid depth 's _ Capacity---- <br /> Disposal 'Field: Distance from nearest well____r -----Distance from foundation_--.-'7------_Di stance to nearest lot line--!? ....... <br /> 1' Number of lines--------I...........____.------- ength of each line-- ------------- of trench-----------= _0`---_-_---•_- <br /> Type of filter material Ac.c�__.__- pth of filter material-----.�1__.---------Total length--------------,f-4.4 ................ \4-j <br /> Seepage Pit: Distance to nearest well----/0.O--------D`stance from foundation---/0...........Distance to nearest lot line-----15------------ �( <br /> Number ofpits--- ____/-_.______-.__Lining mat�rial. d.C_l ____ Size: Diameter_ X__-,,V__..__Depth____,/1110--- <br /> _--------- <br /> -------- <br /> Cesspool: Distance from nearest well ----------------Disfance from foundation________________ __Lining material .__.._._--_--__-_---__._-.--.------. <br /> ❑ Size: Diameter- -- --------------------- -------Depth.------- ------------ <br /> 4 Liquid Capacity gals. <br /> Privy: Distance from nearest well_------------------------- ----- -'Distance from nearest building________________________-_-------------- <br /> F1 <br /> -_ -__❑ Distance to nearest lot linerr------ ---- t -------------- ----------- ---•------ ----- ----.----- - -------- - -- ---- <br /> Remodeling and/or repairing (describe):__._ - -EACf-4_____Ll_14�___-_- (1�-C�'.,.►_F_0_.........FR4!M--------------- <br /> ....................................15----- - �g -------FO 1 -----1 V------------------- -�4�u[-j�E1� - pj. X _x `yo <br /> IN -�. °r-------- a " -------- a�� -- cv Is p t i <br /> - C_ f7. E----FU_!n.( (_I <br /> I hereby certify that I have prepared this application and: that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. FOR, Rd PER FUNCT►O <br /> �� i? :•-� ,�� INE- �� L�R�N Li rv'r— <br /> (Signed): -t 4:..l. ,.'f_y' -�------- ------ - ------ -- - ------(Owner and/or Contractor) <br /> -By•-•..... --------... --- ---- --- ----- - - �T� e)_ __ <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.---- T!-I %� tl-------- - --------------------------------------------------------- DATE- -------------------- <br /> REVIEWEDBY------------------------------------ -------- .------------- -------- -------------------•-----------------------------'DATE---------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------- ------------------- --------------—----- .......................... DATE.----- ------------------- ------ - ---------------•---- <br /> Alterations and/or recommendations------------------ --- - -- ----- -••--•-- --------- ------------------------------•--- ............... ------ ----------.---------••------------•-•--------- <br /> 5 r Aaov� rx�X�L_-- <br /> --------3---------------2-----1-- --------6 <br /> FINAL INSPECTI BY:-- -- Date - ----------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon 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 1-67 Vanguard Press <br />