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4'./1 <br />^� Permit No. __ 11.�° b. �-___-_ <br />Date Issued __-_4.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 Count r�dinanc o. 549. 1i <br />JOB ADDRESS A CATION ------ <br />l_ ------ ---+------ �5 _PI_�' ..' `-=------------- = --------- <br />Owner s Name �_.� `--------- =- 17 T ---------------t----- Phone d J 1 <br />Address-------------_': --------- =�:.= - - r---------•----------------------------------------------- <br />R <br />�. `ti <br />Contractor's Name f -R I i4i� 1 *-�"-i---------- - Phone f- <br />Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Courtx ❑ Motel ❑ .. Other ❑ <br />Number of living units: lumber of bbdroomsNumber of baths _-Lot size ��____AL_�__�_`_________ <br />Water Supply: Public system Community system ❑ Private � -,De.pth to Water TableTO__ ft. <br />�a y a <br />Character of soil to a depth of 3 feet: Sand ❑ Graven❑ Sandy.Loam ❑ Clay. Loam ❑ Clay ❑ Adobe &- Hardpan ❑ <br />r- � t <br />Previous ApplicatiowjMade: Yes. E] -No 9,New Construction: Yes _ .-�No ❑ FHA/VA: Yes ❑ No <br />TYPE OF INSTALLATION AND SPECIFICATIONS:'. <br />(No septic +a�i'te <br />r cesspool permi++ed if pu 'c sewer is available within, 200 feet.)- j <br />ro <br />M_ PP., - <br />(Wj F,.°_.Mate .'�I r 2 % l�C.,Septic T nce from nearest we11____ istance f om-f undation __.. a No. of compartments____ __ _____=Size___ _ ___' Liquid depth___ apacity__________ <br />.r P . <br />_. <br />Disposa Fie4d: Distance from nearest well , .-_ _ = Distance from 'fouridation____rO__ ___-__Distance to nearest lot <br />;• Number of lines _____________1_,_ ______ <br />---- Length of each line_ --_----LO------ ---------Width of trench----- - I-------- ---.---------- <br />rr-.__.Total len th-'.--------t_-�•=-------------- <br />Type of filter material-__ t __Qepth'of filter material____] -_:r g ------- <br />length-; <br />Seepage P Distance to nearest well--'-. {9qy_-Distance9z,11 <br />dation__.__�� "_____-.Distarice to nearest lot line_st_________ <br />Number of �ts`_._�_ _:____' Linin material'_ Size: Diameter__ __.Depth_________________p• ` g� <br />Cesspool: Distance from nearest well_________________ Distance from foundation._-_---- '______._.Lining material ______.__.._:-_______-___________-_- <br />Li uid Ca acit <br />❑ Size: Q�iameter. --�--=---•---------Depth---- f ---------------------------------------------q p Y- ---------- ---------gals. <br />----------------- --- from nearest building_------------------------------ <br />Privy: Distance from nearest well_____________________.____------------ <br />❑ Distance to nearest lot line----- ------------------- •---------- --------------------------- ----------------------------- <br />APPLICATION FOR SANITATION PERMIT <br />------ <br />(Complete in Duplicate) <br />Remodelingand repairing (describe):------ ------- ------------------- �-- ----------------------•------------------'--•-----------•----------------•-i-----------------------------• <br />„ r ` <br />I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules d regulations of the San Joaquin Local Health District. ` <br />Si ned -----------�---------------------�:�•,----------------- ----(Owner and/4Contractor). <br />B---- -- --------------------- ----- - --•----------------------(Title)-------------- - ----- ----- ------ -------------------- <br />(P g - ------------------•--._....- -y---- -------------- , jbe placed on side). <br />(Plot tan, showing size of lot, location of s stem in relation <br />to wells, buildin9 s etc., can reverse <br />FOR DEPARTMENT <br />USE ONLY <br />APPLICATION ACCEPTED BY---- -------------- -- -------�: --------------------- .=�:.-.'-���;:------------------� DATE ----------------- ---------------------------- <br />REVIEWEDBY ------- -------------------------------------- <br />- --- _ --------- .------_'------�-----------�;DATE�------- ---- <br />BUILDING PERMIT ISSUED---------------- _/P, <br />- - - -----------------------�•��*;--------------:: DATE--------= �_'�____-�•-=---------------- - - ----- ----- - --- <br />---------- - -- - - <br />Altera+ions and/or recommendations:-- --------------------------- - ' <br />FINAL INSPECTION BY - --- Date--.. ---- -- -- <br />-- �---- �-0--------------------------------- .------- <br />--- -- --------- ----------------------___-- � <br />a <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American 5#tee# 300 West Oak Street � 132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />E5 -9-2M � Revised 1.57 <br />F.P.Co. <br />1 <br />6 <br />1 <br />