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rvrtrvrrrlrSTuJt: -�--ter <br /> APPLICATION <br /> -FOR SANITATION PERMIT Permit No. .. 1 / -- <br /> y <br /> ----------------- ------ ----------- ------------- (Complete in Duplicate) <br /> --- ------- This Permit Expires 1 Year From Date Issued Date issued <br /> ThiApplican is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de'scrib/d. <br /> s application is made in compliance with County Ordinance No. 549. t <br /> i <br /> JOB ADDRESS AND OCATION_ -_:---- 1-D1=- _ T�? �.l�--d` --r,� t------ -�-lw 1 � �cAc c►� <br /> Owners Name------------ I , r 1 <br /> lli -�1- }-.-------1�±- ....----��L------- ---- --------------- ---- -- Phone <br /> Address T --------I-----`-----1'_Q-X----------1 nZ�---------•ES;R�� <br /> Contractor's Name----------CAf?_G•1L <br /> -------------------------•- ------ ---------------- Phone <br /> Installation will serve: Residence Ej'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ ___ Number of bedrooms _3__ Number of baths /____ Lot sizeC_ E(�_-- <br /> ----------'------ <br /> Water Supply: Public system E] Community system ❑ Private [jj­Depth to Water Table ft. <br /> Character of sail to a depth of 3 feer t: Sand ❑ Gravel E] Sandy Loam E] Clay Loam Clay E] Adobe E] Hardpan [B]� <br /> Previous Application Made: Ilf yes,date--------------------) No 2' New Construction: Yes ❑ No FHA/VA; Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> septic JaA or cesspaal prmitted if public sewer is available within.200 feet.) <br /> Septic Tank: Distance from nearest-v✓ell---- _-____Distance from foundation---/D----------Material. CG7- e <br /> L I No• of compartments-_____'� _________Size_ _ - Liquid depth Z./ <br /> / ---�----------Capacity- <br /> Disposal 1 field: Distance from nearest 'well..... _-Distance from foundation____ o <br /> -�Q____-_-Distance to nearest lot -__-- <br /> �x ��G Number of lines-_�--------1--------------------L_ength of each line5- <br /> Type <br /> C� --'------.Width of trench--'-- 7 <br /> - g ------------ .. <br /> T e of filter material__ Q C 1 ' <br /> Yp --- '-�---_Depfih of filfier material__--/�--- ---._Total len th_._---„�O------------------------ <br /> Seepage <br /> --------------------- -� <br /> I <br /> Number of pits-..___/--------------Linin material__ , e ' Distance to nearest lot fine.... ~-,-- <br /> 2�X /t'7 ' <br /> p g g cry -Sze: Diameter-- Depth- �.-Z-- ------------------- <br /> ee a e it: Distance to near�t well____--.5:7-C)-----Distance from foundation_____ <br /> Cesspool: Distance from nearest well_: __--_-_____Distance from foundation--,_._.-__.-_ - <br /> --_.Lining material------------------------------------11 <br /> 5�ze: Diameter-' ------Depth-------- --------------------------------------------Liquid Capacity_ -------------------------gals. <br /> Privy: Distance from nearest well_------- <br /> _________________Distance from nearest building--_---,---------------_------ <br /> 1771 Distance to nearest lot line ___------------------ <br /> --------------------- <br /> Remodeling and/or repairing {descrie):---------------------------------- <br /> ---------------------------------------------------------------- <br /> I =--•--------------•---------------------------------------------------- <br /> --- ------------------ --------------- <br /> I. ---------------------•---------------------------------------------------------------------------------------------------------------------- ----- <br /> I hereby certifythat I have <br /> prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St laws, nd rgand regulations of the San Joaquin Local Health District. <br /> (Signed) -- �� <br /> ---- ---5_ <br />_ B -----------------_ _ --------------------------------� - - -_`_4 ----- �-'-'------ ------------- --------_----- `-'-----�-'-- -------------{Owner and/or Contractor) <br /> Y: - -- --- - - --- ------ ---- ---- Title ---- <br /> (Plot plan, showing size of lot,location of s stem in relafian o—we11s,buildings;etc.,can bn pla'ced on reverse side): <br /> 1 <br /> FOR DEPARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED BY Pj. '---------------------•----- -------------------------- DATE-' = � `��5�.. <br /> REVIEWED BY F I i -------------------------------------------------------- <br /> DATE----- <br /> -- •--'- -- ----- ----'-- -'-'------ --- -----'------------------'- <br /> UILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------- ---------------------------- DATE <br /> Alterations and/or recrimmendations:” 1 ►T____fir? PTIf---,ttOT__._,[�_}"KK �7 -----'�R��-------=-------------------- �� <br /> ---------------------------------------- <br /> ------ ----•----------------------------------------------------- <br /> -------------------------- <br /> FINAL INSPECTIOW BY:_- ----- ---- <br /> Date _`:C7- f��----- ----- --- ------ ------•- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California rq, <br /> F.P.0 17. -- <br />