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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> ________,1______...-----__._____..._ APPLICATION FOR SANITATION PERMIT Permit No. .,1 �f. <br /> ...........-------------------------- (Complete in Duplicate) tff <br />` Date Issued ______ <br /> This Permit Expires I Year From Date Issued <br /> C g(p — 2-s-0— <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. , "rH RO)> <br /> JOB ADDRESS AND L CATION-. /�_.!'lQ�:.:.: zlg IV;---..or------KID .011�.... ..�1D:_. <br /> Owner's Name----------- L � fJf ---- ------------; ---------t--------------------- Phone............................. <br /> Address. = !"E t..._... G�3 } -�'� -' �------------------- -------------------------------------------- <br /> .�.l <br /> Contractor s Name... ---•--.�?_ IVF-1�.------------------------------------ ' ------- Phone.................................. <br /> Installation will serve: Residence 2 j Apartment House ❑ Commercial ❑ Wailer '+ Motel ❑ Other ❑ <br /> j t Number`of living`units: __. ___ Number of bedrooms Nurnb4r.of baths ._�..."Loth size .___. .__ .__. .................. <br /> Water Supply Public systemommu�ity system ❑ Private ❑� 46.,epth TO Water Table ____:___ f#, l <br /> Character of soil to a depth of 3 feet: Gravel ❑ Sandyl_oam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ .� <br /> Previous Application Made: (If yes,date________.---------) Noir_'Ne+� orstruction:' YesNo ❑ FHA/VA: Yes ❑ No i <br /> TYPE OF INSTALLATION AN6 SPECIFICATIONS: } {" L <br /> _ <br /> r '(No septic tank:orcessp ol-permitted'if public sewer is available ithin 200 feet.) " '' �•°�-'� =rt } <br /> -------Materi I----rl V100.... <br /> Septic nk: Distance fru nearest weil:_ �r�__Dis#a e from foundatiori:°`:��; Q� <br /> No. of eomartments_____-._2.- x -XS'_Liquid depth--------- -------------- Capacity---__ <br /> Size <br /> D'+sposaI .ield: Distance from nearest well._.AIIVALF�_.Distance fromt'foundatio . . .___.Distance to nearest lot line.... <br /> Number of dines = l /".:f.--------------Length of each line--__'+�_ �__� __.!_.._.Width of french.__.___ r . ....___ <br /> Type of filter material._.�Q`C 1�--"---Depth of filter material__:-_/S-7*:-___Total length__________-.•-_•--:•-_A0___�___.- <br /> .' :-,• <br /> Seepage Pit: Distance to[nearest,well_____________________Distance from fouAa}ion_!-....._._.'.__..Distance to nearest lot line-_-_-___-________ <br /> �- <br /> ❑ Number of��its----G__�-------•�___--Lining material---------------------�5ize:.:-Diameter"-----------------"-_-.Dept h----=------------•------__"_-- _ , <br /> 9 r, " � ,tr�• a <br /> Cesspool: Distance from nearest well_________________Distance from foundaTon_i__.---- __ ._--.Lining material..______"..___.___.------- <br /> __________ <br /> ❑ Size: Diameter Y bepth •�It �'} - Liquid Capacity-. -._....--•----------- -gals <br /> Privy: Distance from nearest well. ______`"' --J................Disfance from :nearest building---------------.-_--.___._____.___.______. <br /> ❑ Distance Onearest lot line------------------------------------------------------------------ <br /> Remodelingand/or repairing (i escribe)-------------------------------------- ------------ ........-------------------------------•-- -------------- ----------------------------------- <br /> =------------------------------------•-------------•--------------------------•--------•----------------------------------------------------------------- ----------- -----------------------------------.------.-------- <br /> 7---------------------------------------I.._...--- �-------- <br /> ----•"------------•---------------------------------------- <br /> ----------------------- <br /> ----------------•--------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State aw , and rules and:regulations of the San Joaquin Local.Health Distric . <br /> (Signed}._ /. _ __ i----------------------(Owner and/or Contractor)/ <br /> By:.....-....................................=__=:__:: -" ---------------- =- _ _:: = - =_-{Title}-------- <br /> ------------------------------------ <br /> ---_:. :-._.- -- <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 I <br /> APPLICATION ACCEPTED BY:" ---- .1 1._R-_05--------------------------------------------------------------------- DATE--- <br /> REVIEWEDBY------------ ; 1-------------------------------------------------------------------------------------•• DATE---------------------j----------.` ... <br /> BUILDING PERMIT ISSUED ----------------------= - DATE ' -­------------------- <br /> Alterations <br /> .; € - <br /> Alteratio/ns and/or recommend'a/tiocnss..11 R-- • -7�i�--------I ----------------- ------------�---------).... "-------------------- ".` ' <br /> ---------- !__�� .`_ ---- ----��'l s-L:-C=3_ISD_.-----�'-'`�. I1Fr {r...7:* L. -----__l__ L_1:©_r.......-------•------------••--_1--••-•------•--4==------------------ <br /> -- ------------- ------------ - ----•---- <br /> --.-•-- Cr- 3=�'-- - 7 N -----®. ------- �r P c-( s: �.. i ,Q ------------------------------------- <br /> _y �. <br /> FINAL INSPECTI Date------7 —------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 9th Strut <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REWSED B-59 2M 5-62 ATLAS <br /> • r <br />