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'FOR OFFICE USE: "` w <br /> ----------- ---------------- - ------------------ ---- - � APPLICATION FOR SANITATION PERMIT T Permit No. <br /> " -_--_ <br /> " --------------------µ------- ---- ------- <br /> (Complete-in Duplicate] �a Date issued <br /> --- ------ ----------------- - <br /> ------- This Permit Expires 1 Year From Date Issue <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> J08 ADDRESS AND LOC TION 70�t-�-- -E-------R-lv_ _ R;I_.PQ^�-` <br /> Owner's Name--------------------- <br /> 1x!_ _ _ - 1tf PtN`D><� <br /> ----------------• � V <br /> _q L'g: 9� L°-ri'1 N`S1�_'t_'��.----- f�_`�e�?-�- --• -Q1 e ZG7---_�_'. "----- "-y _ -,_.. __... - - -•---- �_-- <br /> tt L --- i EIS <br /> Address---------- fa.., T-- - <br /> � ---------- Phone - <br /> Contractor's Name____�WN�"�-".------•----•- <br /> wAfkM4.-. - s <br /> Installation will serve: Residence FF Apartment House El Commercial ❑ Trailer Court E] Motel ElOther [I <br /> Number of living units: J.... Number of bedrooms " <br /> _._ Number of baths 3_ Lot size ----14-'F - `--------------- <br /> Water Supply: Public system ❑ Community system Private Z_�`Deepth to Water Table r5?- ft Adobe Hardpan [_1Character of soil to a depth of 3 feet- Sand Gravel [I Sandy LoaPn A. <br /> Clay Loam ❑ Clay E] <br /> 11< <br /> Previous Application Made: [if yes,dote____-_-_-_-.-_----- 1 No Ner C�stru}ion; Yeso E] FHA/VA: Yes �No El <br /> - TYPE-OF-INSTALLATION`AND-SPECIFICATION S. <br /> (No septic tank or cesspool permitted if public sewer is available w`#hin 200 feet.) <br /> Septic T k: Distance from nearest well .-5P....Distance from foundation_10-----------.Material _t� - �C�----------- <br /> sea <br /> No..of compartments Size-. _x_-/Q Ligwd depth--- S ........Capacity-- <br /> 10.--__-_-_.Distance to nearest lot line_! f5 Q <br /> Disposal Field: Distance from nearest well._. _._._Distance from foundation_-- Width of french------ .. <br /> ®/ Number of lines ........ <br /> www --------:)•-_Length of each line-- .-- •��-- ---��"---- <br /> Type of filter material_--RO J4k -Depth of filter material 9___ ----.Total length____________________ ��© <br /> fSeepage Pit: Distance to nearest wellx.�-"��`�Tpistance from foundation____________________Distance to nearest lot line........--------- <br /> ❑ v's—1'i --Lining material-------- ------- Size: Diameter--------- - --- Depth <br /> NumBorrrof pits--- --------- _ -� -�.--- --+ <br /> Cesspool: Distance from nearest weil -------------_ Distance from foundati.on._._.._-_a,.---- _.Lin <br /> ing material__-__.-_-__._-._____-____-_-_____.___ <br /> r I\A,,) �3�`]. ---- � Li uid Ca acit gals. <br /> ❑ Size: Diameter- ------- -- -- --------- - -Depth---- - - - - g Capacity <br /> Privy: Distance from nearest well-_______ _________ <br /> `��D�istan`e�f from nearest bui!'�in <br /> 9 <br /> t -------- - ------------------------------------------------------- <br /> ----------------------------- --------- <br /> I ❑ - Distance to nearest lot line"��-------- - <br /> TI . <br /> r l � y <br /> Remodeling and/or repairing (describe}:------- --------- <br /> i <br /> ------- <br /> . <br /> ------ - --- ------- ---------- !"--- <br /> -- -------------- ------ <br /> 1 <br /> ----- # :i'_! <br /> -------------------- ` <br /> - <br /> !hereby certify thaf_ I have prepared.fkis application and that the work will be done inra�cordance with San Joaquin County <br /> ordinances, Ste a laws, ah rules']and gulations of the San Joaquin Local,Health District. <br /> !_:D <br /> ? ` f <br /> - t {tip <br /> {Signed) - - ----- Y- -- :. -.�z _ Contractor] <br /> r- <br /> ...--..(Owner and/or <br /> �� �- ---`--- Qvt.,C IJ fC V ;r - _----- -- - {Title) f <br /> 3 - ----- --- -- <br /> (Plot plan, s owing size of lot, location ofysyste din relation to walls, buildings, etc., can rbe place on reverse side]. <br /> E l <br /> s •. <br /> ;FOR DEPARTMENT USE ONLY Y { <br /> € � i__ -------- :_ --- <br /> ••� -- DATE-. ----.5-T--g. _. <br /> APPLICATION ACCEPTED BY - - R.._c/-` - 1.:DATE------ -------- ----------------------------"-"----•- - <br /> 1 { -------------- ---------- <br /> REVlEWED 13Y- _ f r•. <br /> BUILDING PERMIT ISSUED_ --- `I-------------------------------------_ - _- .._,_.. - <br /> w <br /> - ---------- ---- <br /> }a i.:. ..�.x ------- -• ---- <br /> -'---'_--`--'--r:'----.�-------------------- --- <br /> - - --ti <br /> ---- ------ <br /> Alterations and/or rscommenda+ions: .-.__-_---- -- - --- <br /> ;� <br /> 1 iJ l r ---- <br /> - = <br /> ---- - ------- <br /> --------------------------------------- <br /> ------------ <br /> x <br /> /�/L__ .-___.-.._--__________________________ <br /> I FINAL ! - -- -- ----- - -- - • - - - - - <br /> Date----------- --- --•----- ------�-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> X1601 E.Hatetton.Are, 300 west Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California <br /> Manteca,California Tracy, California <br /> E.K.9 2M 1.67 Vanguard Press <br />