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FOR OFFICE USE: h <br /> �. <br /> --------------------------------------------------------- <br /> -_.___..... APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------------------- --------- (Complete-in Duplicate) bate Issued 52'"-�_-:5-_-_Z i <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 /> r,kis application is made in compliance with County Ordinance No. 549 <br /> IX <br /> . ,,per ... <br /> JOB ADDRESS AND LOCATION.._.-- /r� -:--__. _.!G-E! -- '' --- /- •_ - I�� <br /> OwnersName---------- 1 __._. .. ------- ---_ ----------------------------------- Phone-------------- -------------------- <br /> Address------ ° ........ ... <br /> Contractor's Name------ . <br /> ------------------------ ------- ----- ----- • - ---- - - ----- ------ Phone------...----------•---------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercials❑ Trailer Court ❑ Mofel ❑ Other @g.- <br /> I <br /> Number of living units: __ -__-- Number of bedrooms -------- Number --_----- Lotze.-0/of '°---t --- <br /> -------- <br /> -------------------------------- <br /> Water Supply: Public system ❑ Community system ❑i Private g��Depth to Water Tablee%fti <br /> Character of soil to a depth of 3 feet- .[Sano' E] Gravel ❑ Sandy^Loam Clay Loam E] 'Clay ❑ ,�Adobe ❑ Hardpan ❑ <br /> k _�..s <br /> �'` `New Construction: Yes ❑ FHA/VA: Yes ❑ No , <br /> Previous Application Made: (If yes,daSe___...-_._�_ �..-: No t <br /> r - � , r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 f•eet.)� # t <br /> Septic Tank: DisNotaof com artmenest well,�;�0__:D Bance frorr��undation,�,�'_-p.__�.:Mat��1 i--- --- <br /> No. <br /> '�.'C�_�."1:"�r <br /> pa <br /> Disposal Field: rDistance'from near t well /—1 Distance from foundatii n_� -� -- -.Disstance to nearest l ty�Cl49 <br /> r o <br /> p .... ar a lot line_` ' <br /> i i <br /> W� Number of lines ' ` <br /> __----- Length-of each line_ .. �-.Width of trench_ ��--------------- <br /> Type <br /> ______________________ <br /> T e of! materia Z_,��r �� �' 'Y I <br /> yp I /F _Depth of filter material---f _____._-.Total length=_, � ___------- <br /> -------------- <br /> Seepage <br /> __________________Seepage Pit: Distance to.nearest well-.-._: Distance.-from foundation--------------------Distance t&neayest <br /> ---Depth „.� ----------------------------------- <br /> _ r <br /> lo <br /> t line_ ________._-.- <br /> spNumber*-6f, ? 1` Lining ze: Diameter- - pth_- .t----------------- <br /> Cesspool: Distance from iearest,weil ____._.:: -._ Distance from foundation__ __ _ _ ___ _ _ Linin materialt....._ <br /> ❑ r—•Size: •Diameter- _. _-­ _.- --------------------- - -----------Liquid Capacity----5; .!--------------------gals.,.” <br /> >' <br /> -j <br /> Privy: s Distance from nearest well____ ---------- ________________________--------Distance from nearest building-----w._____ ---------------_._-_----... <br /> �.. E --------------------------------------------------'--"- l� e <br /> Distance to nearest lot-13ne -.€..-----.__..A { ------------ ----- "� <br /> ------------------------ <br /> Remodeling and/or repairing (descril eJ:__.. �s,� Q �� _ _�_--------la.._... <br /> y ,1 ,.,•.. , - ----------------------------- <br /> .'.. .�.....r...� {� <br /> .............. ...... - _ <br /> {J ______ .._______ __-_ _ .._ _ _ <br /> --------- `. .5 :--- --- -- R =1v " <br /> ---------- ------------- ------------------------------------------------ <br /> ------- , <br /> -- ---------------------------= ---------- - <br /> = r-- <br /> I hereby certify that I have prepared this application and,that the work k1lbe doge in',accordarme with-San Joaquin County 1 <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Z i <br /> (Signed / � --� --------------------- (fir Contractor( <br /> By: - d��' - ------------- .(Title)---�* _. - ------ - <br /> Plot Ian, showing sae oftlot, location of`s Ste relation to wells, buil <br /> ------ ---- ---- - - <br /> ( p g y • F �dings,` etc., can be placed on reverse side). <br /> rk FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ <br /> ? �.. .�`M. ` DATE-- d-"- - ' <br /> REVIEWED BY. -------------- ------------------------------------------------------ ------ DATE <br /> BUILDING PERMIT ISSUED-------- -- _Z--------------------------- DATE-------- --------= --- - <br /> Alterations and/or recommendations:- 7------------ -------- -------------- ---- ---------------------------I-- --- -- t i <br /> ----------------------------- ---- - ----------- -� ------------ ---- i -- ----- <br /> - - <br /> - -------------------------------------- <br /> f I € I <br /> ........................ <br /> `--------------------- --- -------- -•-----• ----- ----------------------------------------------------- --------- -- ._.:.----------------------------------- <br /> sl i <br /> ------------ --------- ................... ----- ------- .�; ---------------- I <br /> q` <br /> -------------------------------------------------------------'"-------•. --- .............. ...... �---'------------------------------------------------- <br /> ------------ <br /> ---------------Wr----------- ------ - -- ------ --- - - ---•---------- <br /> T --------- <br /> -�� N. <br /> FINAL INSPECTION BY: � ------- <br /> e-� SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Avi Za300 West Oak Street { <br /> 124 Sycam roe Street 1' ; 205 West 9th Street <br /> Sloekton,California '►,.ea -Lodi. California x � d� Manteca,California Tracy,California <br /> E.K.92M 1.67 Vanguard Presse- Y <br />