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FOR OFFICE USE: <br /> _____..-___-----------------------_- APPLICATION F R SANITATION PERMIT Permit No. .23:1 ?a <br /> "' - ' r <br /> [Complete in Duplicate) 31-73 <br /> .-------- <br /> - -w �. .�,. Date]ssued .-_1.1 <br /> ------------------ ----- ------ _--_� This Per`mit`Ezpires T Year From 'Date Issued r <br /> Application is hereby made to the San Joaquin Local Health District,fbr'a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No.;549. { <br /> JOB ADDRESS AND LOCATION : ------- --------- _ 4 - { --------------------------------- ------ -/UO--oy <br /> Owner's Name _._..._...•----------------------- ------ --- --- -------------- -------------------- Phone .- -7-------- <br /> Address.. of ��--_..JI --- - --- ------*---- --- -- --- •- "- -- ------ -----------------------------------`---------------- ----------------- <br /> ') zZ <br /> c <br /> Contractor's Name---- =6 i . .. -- . - --------------------------------- Phon,0_J <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] <br /> Number of living units: __ ._ Number of bedrooms . _ Number of baths__[____ Lot sizeli-t_____.____ <br /> - -- -- -- (------------------- <br /> Water Supply: Public system' ❑ Community system 0 Private EXL Depth to Water Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ <br /> PreviousApplication Made: (If yesATION A ,date------------ ) No New Construction: Yes No ElFHA/VA; Yes ❑ No ❑ <br /> ,TYPE OF INSTALLATION SPECIFICATIONS: y4 <br /> (No septic tank or cessp of permi#ted if public'sewer is available within 200 feet.)� � ��,�_ � _• <br /> Septic Tank: Distance firom neare`sf well -------Disfwre from founclatic2nl-o_ . Material -- -----''---'`.--- --.--� � <br /> 91 _', .,� No. of co'm' partment s___-_-.-- _ - Sizt3'T.__ _____�C Liquid depth._.-— /41' Capacity.tv ---____-- <br /> Disposal Fie& from nearest well tTO.,.,_Distance from foundation-f_�r -------_Distance to nearest lot line,3 _._ - , <br /> _ Distance <br /> Number of lines __.___�__ _.__ .�_/_- Length of each line__.._ ���7 Width of trench.__5`F_-.__.-.__________ ti . <br /> 'f Type of filter material._______.d ___ --Depth of filter maferial___-j'C..______....dotal length_�Bat �--------_--------- <br /> Seepage Pit: Distance to nearest well-----_------------_---Distance from foundation--------------------Distance to nearest lot line_------..--__-.-_ <br /> ❑ Number of pits--- --- ............Lining material---------------------- Size: Diameter-----------------------Depth------------ --------------:-..1 <br /> Cesspool: Distance from nearest well --------------Distance from foundation---------- Lining material,-- <br /> : , material,_ _ ____ <br /> _____ <br /> ❑ Size: Diameter -- -�-��--- ------------ <br /> ----- <br /> ----------- ----------------�e ---------�- -�-�-�----. -----... -----Li Liquid Cap �tgals. <br /> Privy: Distance from nearest well____________________ _ __ __ Disfance from nearest buildingIf- ------ ---------_ <br /> 11 <br /> Clip <br /> ❑ Distance nearest 16t,line <br /> NJ <br /> ' t {srC-1r--- --±RSL.t7 ---- ------------------------•---- <br /> Remodeling and/or repairing(describe):_.�"�r'L-�.t,�••a."-�-�-------•---------•-----------•--•-•--•------=-----=--------°=--= ------a. ----• --- ------'.:-----•-------- - <br /> ---------------------------------------------------------- ---- <br /> Mf ---------- <br /> - -- --- ----------- -------------_--------•-;_- --------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have laws, and rue prepared this application and #hat the work will be done-in-accordance with San Joaquin County <br /> ordinances, <br /> les and regulations of the San Joaquin Local Health District. I <br /> (Signed ---- -�------- _ --T�_'- -------------•--•- -- -- -------------(Owner and/orlContractor) <br /> By:--------- { } -------------------------------- <br /> (Plot plan, showing size of lo tion of system in Latton to wells, uildings; #c., can be`placed aryn�rewe�rse side). <br /> .'i FOR DEPARTMENT,USE ONLY` <br /> APPLICATION ACCEPTED BY- -f.. - _.. ----------------------------- <br /> DAT---'�-- -- E---- / � ... .................... <br /> `'--'--- f`f ----- DATE---------------------------------- <br /> REVIEWED BY------------ - - <br /> BUILDING PERMIT ISSUED-- `L__k - ----------------------------------------------------------------- ...... :----- DATE--- ----- ----------------------------- #-------------------- <br /> Alterations and/or recommendations:---` --------••- ------------------ -- . . . — . <br /> ----------- ------- ---------------------------"---------------------- ----------------•---------- -------- ...... ----•--- ---------------- ----------------- ------------- ----- ---------•-----=-------------------- <br /> F <br /> ----------------------------- -•-------------'p-------" --•--- -< ...... ­--------------------- -----•----- ------- -- -- •----------- .---------------- ----------------- <br /> 1 <br /> II _.f - ---- - <br /> ------------------------------- ----------------- -•---------------- -- ............. ------- -- ----------- <br /> /� <br /> FINAL INSPECTION = Date F <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California I� Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press II <br />