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FOR OFFICE USE. <br /> ---------------------•-------- - ----------- <br /> ......I ....... --------------------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ..............7------------------------------- ------ (Comple+e.in Duplicate)................... ---- ----------- This Per 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 /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIONI'l-l-D-W-A-Y--- ------ <br /> I— --- _ 4------------------------1"I-------- <br /> Owner's Name___ _ A AKansbe_y---------------------------------------------........ --------­---------- <br /> ----------------­- PhoheWJ_?—A!%P_7----- <br /> Address--- <br /> ------------------------...................... ... --------------:------------------------- <br /> Contractor's <br /> ' <br /> Installation will serve: 'Residence El Apartment House E] Commercial E] Trailer Court E] Motel 0 Other <br /> Number of living 'Units: A.- Number"of bedrooms Number of baths.At,- Lot size_.A--- e—___________________________ <br /> Wafer Supply: Public systern E] Community system E] Private a Depth to Wafer Table -70- ft <br /> Character of soil to a depth of 3 feet- Sand C] Gravel 0 Sandy Loam X Clay Loam 0 Clay F] Adobe Hardpan C] <br /> Previous Application Made: jlf yes,date__.......-..___._._ I No V New Consfrucfi6n':-Yes No El FHA/VA: Yes E] No E] <br /> TYPE OF INSTALLATION AND,SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available wifliih,.200 feet.) <br /> Septic Tank: Distance from nearest well-3.d0__--Distance from foundafion-1,S-66.. Material ---------------------t------------- <br /> No. of compartments_----------A-----------Size__t'a,6_0__6,j4_4__Liquid ciepth-- ------ - ------- <br /> Disposal"Pleld,:—Disf6rice from nearest well-- Distance from fcurdaflon__A,5_6#-------Distance to nearest I ri,___� 'D <br /> 3 lot 0 <br /> LIN —Nur6ber of lines.___________ Length of each line_Lob i of trench <br /> Type of filter material----- ---- -- ---- epth"of filter material____. ___._____._Total lengfk---- --- 0 <br /> Seepage Pit: Distance to nearest well..-------t I t----—----Distan(fe-from-foundation-----�-".;-..Distance to nearest lot line_________________Nur-bber of Js._--- ---------------_111ning rjia/teria�-------------\-------� Size: Diameter;---------------------Dept h__ -------------------------- <br /> t. 1 -7, _!:9 I ) *--,I J-I '! 0 <br /> esspool: Distance from nearest well --- ------Distance from foundbfion_ __..:..___J ..Lining material' ------------ <br /> S.Z <br /> Diameter:'� <br /> I e: ...........7x—Depth . ........... --------I--------------- .......-Liquid Capacity--------------- -------------gals. <br /> ) ------- ----- <br /> pPrivy-, kl3istanice from ne est1well....__.____f_____________________________ -_ Distance from nearest bu*ilding,-.------------ ---- <br /> ------ --- ----------- <br /> - <br /> Cl Distance to nearesf'lot Sine_------j------ ........ <br /> 4 --------------------------------- --------- ----------------------------------- <br /> - <br /> �p i7c_r I ------------- ------ <br /> Remodeling and/or re�j�i g (a be).-S-9L. ------ <br /> 1, t I <br /> ------------------------------------------------------------------------I--------------- 1 11 <br /> ----------------------- - <br /> ----------- --- -==-- <br /> ------------------------------------------------ ------------------------------------------------------------ <br /> ------------------------------- 4 <br /> - -- ---------------------- ----------------------------------------------------------------------------------------- ------ <br /> ------------- -------- -- ------- --- <br /> -; I <br /> ----------- --------------------------------------------------------------;--------------L -- --------------------------- ---------------------------- ------------------------------ <br /> I hereby certify AW1 have p'r'e-papplication and fhat the work-,will'be done in accordance with San Joaquin County <br /> ordinances, State laws,'and rules and -r6gulations of the San Joaquin Local H'ealffl District. <br /> L <br /> -(Signed) . --i. — (Owner'-"a6r-C <br /> d/oontractor-)BY .,,-6�l., <br /> L�CD_qskzi tqj C, <br /> ....... .... .......... <br /> -------------- ------------------------------------------(Title)-- <br /> .......... <br /> (Plot plan, showing.size of lot, location of sy59m in relation to wells, buildings, etc., can be placed oA reverse"id-6)' <br /> relation <br /> , <br /> FOR DEPARTMENT USE.ONLY <br /> APPLICATION ACCEPTED BY._..rfA-0 <br /> l S <br /> - - - ------------------------ <br /> ---------------------------------------I-------- ... .... ----------- DATE-- <br /> REVIEWEDBY-------------- ----------------------------------------- '- —--- ------- -------- .... DATE-- ---------------- <br /> BUILDIOG-PERIVI-IT4ISSUED------------------------------------------------ ------------------------------------------- <br /> ------------------------------------- - ----- DATE <br /> Alterafio6i'-a"n'a7or—re'c'of�nro�-nda�;ons:--:-�:-A <br /> ---- -- <br /> ---- ---------------------- - ---------------I------------------- -------- <br /> ---------------------------- ----------- .......... ------- - - ---------- -------------- ..........------------------------- <br /> - <br /> --------- <br /> ----------------------------------------- --- - ------ --- - ---------------------------- <br /> ---------------------------------------- ------ ------9----------------- ---------------- ---------- --------- <br /> 71---------------- <br /> ------------------ ----------------------. ---------- .. ..........-.-.-.- <br /> FINAL INSPECT BY: .-.-.-.-.-.-.--.----------------------- -.-.-..-.. - -.-.-.-.-.-.--.-..--.-I-I-------------D----a----f--e---A--—------------------------------/------/-------------------- --3_ <br /> -- - <br /> - <br /> ------- <br /> -------------------------------------------------- <br /> --------- <br /> 11?3------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California �Ma`nt.ca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />