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FOIL OFFICE USE: �• r <br /> -,-: f 2- 6 <br /> 'APPLICATION FOR SANITATION PERMIT Permit No. _....------ •-••--•--- <br />--------------------------------------------------------- <br />..-1----- ------------ ------------------------------ <br /> (Complete in Duplicate] .�� } <br /> T SEU E.✓T+f{;I Date Issued ................. <br /> 1„Sl. ---._--------7------- ---------- -- -- This Permit Exeires 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 49rh;rein_ y <br /> descr�ed. <br /> This application is.m de in compliance with.County.Qrdinance No._549: a- <br /> --3 <br /> JOB ADDRESS AND LOCATION -: ! - ..OF_.. =-- �`'.... 3.' �_ Tl��E3 P <br /> 4� f" <br /> Owner's N-me--------FRO-N`K.......... Q -•------- -----------------`- Phone <br /> Address-­P Q`-•-••-.R0X•••---... _- ----T e ------------------------------------...................................................................... <br /> �_.. <br /> Contractor's Name. - Alt a ------------------------ <br /> I <br /> -------------------- =-------••---•-• Phone.......-•-•------------•--.. <br /> Installation will serve: Residence VT, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> I - --r- - - 0 ............ <br /> Number of living units: _�..._ Number of-bed,rooms=�__w'Numbar of�batlis .�.._._ Lot size ....-�-�'_�_._�._�..-� ------------=-- <br /> Water Supply: Public systeim IffOCommunit;rseM-O—Privlate-E] .Depth;.ro Water Table �ft. <br /> Character of soil to a depth,of 3.`feet: Sand ravel ❑ SandEly Loam Clay Loam (] Clay ❑, Adobe❑ Hardpan ❑ I <br /> Previous,Application_Made: ;;llf yes,date---------------------) No New Construction:-Yes.. No 0 'FHA/VA:�Yes Nn �' I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank ir-cesspool <br /> esspo of p irmi 4`ed if public sewer is available within 200 feet.) ' ®� <br /> Septic T Distance from nearest welI&NF:.Distance from founds ion... r _- <br /> No. of compartments-----___��._....._Size.�_x..C1 . . ter.'aL...-.-)( Liquid depth___.- �------.--Capticity...; E.p------ <br /> Disposal Field: Distance,fro near t w']IS N-ff.Distance from foundation .'-_......- <br /> e. � Distance to nearest lot line._��...... <br /> [�� Number iof�lines.. ...... ........ :...Len th�of7each line.s� .5....Y .�IVidth of trench... _®�f..-_....__..... 11 <br /> p Type of filter materiaF'F?QCiK__..-.Depth of filter materi .- -�'"..=...Total`length___.._-1.�...................... <br /> Seepage Pit: <br />! ❑ Disance to nearest well_ _-- --' i� Distance from foundation D-----------------Distance to nearest lot line............ <br /> Nutbe -- g iameter-------:--------------- ..... i <br /> Depth-------._.. ...------------------ <br /> O <br /> 'Cesspool: Distance,from nearest well.................Distance from-foundation.:.----------------Lining material_......_-__.__._...._.-.__._..___._. <br /> [) Size: Diameter---- :---•-------------- ....Depth­-------------------------- - r --- ------Liquid Capacity---------•----•----- -•----gals. <br /> ;Privy: Distance from nearest well..................... Distance from nearest building--------------------........._...-._-..._ <br /> ❑ - .. y f J ti3v:.t i <br /> Distance to nearest lot ime-------------•-----------•-•--- --------•----------------...........-----------_-_-.--------------------------------•-----------•--•-------- <br /> �Remodelin and/or re airin' describe :...... - - _ '� --------�c� 'r 1���s - ..--- - -�£�-.f------. ----•--- <br /> ----------------•--------------- ........................:-_-------------- ---------------- <br /> W <br /> s <br /> ------ <br /> _ s ---------------------------------------------_-'---£---- <br /> { -- '. <br /> - <br /> hereby certify that I have prepared this application and that the work will be donelin accordance with San Joaquin County r <br /> 'ordinances, State laws, and.rules and regulations of the San Joaquin Local Health District. <br /> (Signed] . <br /> - =` ':�r.-: :.'- _.:.. •- {Owner-and/or Contractorl- <br /> ____:�-,. ----------1 (Title)--'----------- --•----------------------------------------- <br /> Y <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED. BY-----T-1--L?--`- =------------ -•--------------------------------------- --------•-DATE----- .� Tn, `�------------ <br /> ------------ <br /> REVIEWEDBY---------------------- --------I--------------------------------------------------------------------------------. DATE----------------------------------••-----................. <br /> BUILDING.PERM IT..ISSU.ED.--.--•.-•-. :'------ -_:_-.:........... <br /> -. <br /> Alterations and/or recommendations: ----- ------------------------------ --------------------------- --------- ---------------------------------------------- --------------- <br /> �t <br /> i ..............................L <br /> .......... ... .................•.-.:...._---......._.__.........._..._•--------.-_...__...__.........__......___...._._...__._»....- <br /> ------------------------------ ---------------- -------- - ------ ------ ---- ---------------------------------- _o, <br /> I =y' -----•----- ------••---•-•-----•--------------------------------------------- <br /> ---- ---- - -- ----- <br /> Date. = .. ---�•`-•-------•---•--- <br /> FINAL INSPECTi SY` r t "-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> I -Stockton,California Lodi,California Monfeca,California Tracy,California <br /> 3 <br /> 3 <br /> ES 9 REVISEDl8:t59 2M 9.62 ATLAS <br />