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FOR OFFICE USE: i <br /> r --------------z -._----- Permit No. . --�- � <br /> APPLICATION FOR SANITATION PERMIT <br /> .. --------------------- --------- <br /> - <br /> (Complete-in Duplicate) <br /> Date 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 /> PP . 549. <br /> Al <br /> t <br /> This application 1s made in compliance with County Ordinance t o �,E'� ut - � <br /> JOB ADDRESS AND LOCATION _ <br /> �� �.,_� .�. y.w - ------------ <br /> 14-1E Phone_ ,! _ _7-�r__ --- <br /> Owner's Name - <br /> --------- <br /> E <br /> Address ----• i--- '��--- #.. <br /> ~ -------------------- Phone------ ----------------,. <br /> Contractor's Name--------------------- -i--------_-•-•- -��'��'�`�--� ;/----�``-�'�- �- t <br /> l <br /> Installation will serve: Residence Apartment House ❑ iCommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms _X1 Number of baths-_�_ Cot'siie "' --"T`-- ------- ••--------- --- <br /> . <br /> Water Supply: Public system ❑ Community system , Private El Depth to Water Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand F] Gravel ❑ kandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan F] <br /> Previous Application Made: (if yes,date_-... !___ f No New Construction: Yes ElNo'❑ FHA/VA: Yes ❑ No E]1 - �h <br /> TYPE OF INSTALLATION AND SPECIFICATIONS ' 1411 <br /> (No septic tank or cesspool permitted if public sewer is availa� le i;4hir 200 feet.) ' t # f <br /> Septic Tank: Distance from nearest well-------------___Distance fros�`' foundation..._.I..__-.-----.Mat�rFai=�-_t__._.....h-------------------------------- <br /> ❑ No. of compartments-J---------------- ----Size.-- ? :-;• ...... <br /> LigDid-depth--------- - --- � .I.._ Capacity----------------------- <br /> ce from foundation__-.. 4_-___.._.Distance to nearest lot line--_/a�____- <br /> Dis osal Field: tf iNumber"8f n sear------ ll-----------------Length of each hne_..__/Z>------.------.--..Width of trench._r�-,y________------_- <br /> ar N 6 <br /> £Type?of; filter material__..__..._.Depth';of filter material----A -_..r_.__.Tot length_.__.__._ _'_____ ___________�__�_ <br /> 4 <br /> Pit: Distance to nearest wel .......Distance from foundation--_.___LS,.._____Distance to nearest lot.im --- <br /> Seepage _. . <br /> Number`of• ts1 I f g p .W- ----Depth�---�>'`y ------------------- <br /> T <br /> -------------- (� <br /> _Linin material` /�C�I�------- Size: Diameter._ <br /> Cesspool: Distance from nearest well ___... - ---Distance .from foundation................. ..Lining material___-_ _-..__ _..._____.__________-__. <br /> Size: Diameter. ;; ------. Depth----------------'-`- �---------- ------ Liqui��apacitY ' 9a1s. <br /> I Privy: Distance from nearest wellN .............___..____---.-....__---._Distance from nearest building I <br /> ❑ ) <br /> t <br /> Distance to nearest lot line- --- -�`'• -------------- -- ------------------- ------ ----•------- ----- <br /> Remodeling and/or repairing desc�ilae'`.. 3% r. JC-.-�-- - --------•-------- --------- ------------- <br /> - <br /> ------------ <br /> ~� t <br /> -------------------------------------------- ------------ -------------------- --------- -- ---- ---- ------------------------ - - ---- -- --- <br /> h'k, <br /> ( F: g <br /> r .--—' I <br /> I hereby certify that I have prepared this application and that the work will be done in accordarice with San Joaquin County <br /> ' ordinances, State laws, d rules and egulations of the San Joaquin Local Health District. <br /> i 4 <br /> Si ned t4�C ''" '- �' (Owrferabd/or Contractor) <br /> 9 )----------------- <br /> SY= `"° -------------- -- ----- ;------------------ ---(Title)---------- ."-- " <br /> (Plot plan, showing size of lot, location of system i reation to we s, brlildings, etc., can'be placed on reverse side). <br /> f FOR DEPARTMENT USI-ONLY q - <br /> APPLICATION ACCEPTED BY.- '� t--��--�- -------- �----------`-----------\ ---------- DATE---41.- -�'_[__ -S .-------.---L-' `---- <br /> I I <br /> TE <br /> A <br /> # .-- ----- ------------------------ -----------REVIEWED BY--------------------------------- --- -- ---------------------------------------- <br /> -------------- <br /> - - - :DATE ----------------. _BUILDING PERMIT ISSUED-------- -- - ----------- - - -- ------ <br /> ... <br /> �. <br /> ..%` <br /> ---------- ^tr - <br /> Alterations and/or recommda#i ----- - - _ df.} <br /> ''` -------- <br /> - ' <br /> t - <br /> y <br /> -- t <br /> -------- - r ----- ---------------------- <br /> ------------------------a --- ---- <br /> II „ek �1 - ------i-------------- - - - . .-------- { - <br /> ------------------- �---..... <br /> } ------- ---- <br /> -7-:e <br /> -._ -_ <br /> ---- <br /> �^ 'talir � .�-- <br /> FINAL INSPECTION BY:...... -2 _?-._.. _._. Date--- - - ----------- <br /> - {1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> . <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Lodi, California Manteca,California Tracy,Califorflia <br /> Stockton,California <br /> E.H.9 2M 1.67 Vanguard Press <br />