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1`6�,OFFJCE USE: <br /> ------------------------------------------ <br />- -------------------------------------- ----------------- APPLICATION F9A_--SANITATION PERMIT Permit No. <br />---------------------------------------------------------- (Complete in Duplicate) �//5 <br /> . i - Date Issued <br />-------------------- ------------------------------------ i-This Permit,Expires-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 work herein described. <br /> This application is made in'tcmpliance.with CounTy Ordinance No. 549. <br /> LV7-SZ) <br /> 147 2 � - _600-------- ----- ----------------------------- ------------ <br /> JOB. ADDRESS AND LOCATION_-------------- ------- ------- <br /> .7 <br /> s Name---------- -------------------------------------------------------- Phone------------------------------ <br /> ------------------------------------------------------------------------------- --------- <br /> rp -- -------- <br /> ss_--------------Pi_at------I -__5_57---------_TRA.V---- <br /> Contractor'& Name---- ------------0-VU IV a_K----------------------------------- --------------------- ---------------------- Pho'ne---------------------- <br /> Installation will,se rye:V Residence Apartment House 0 Commercial E] Trailer Court-Ll Motel 0 Others ' <br /> Number of living units: Number of bedrooms..?:___ Number of baths Lot size --------------=--- <br /> Water Supply: Public system 92--community system 0 Private F Depth,to Water Table -0-- ft. <br /> Character of soil to a depth of 3,feet: Sand ❑ Gravel E] 'Sandy Loam}Clay Loam 0 Clay 0 Adobe [3 Hard pa <br /> Previous''Application Made: (if yes,date. -------:-------- No 2'�New Construction: Yes Pe'No F <br /> A FHA VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available t" within 200-feet.) <br /> Distance om found ion <br /> Septic ank: Dlstance from nearest well-- fr MaferiaI__,R1=Fi?_WL7j9j�__)-------------- <br /> Size = <br /> No. of compartments-------112—-------------- ----Liquid depth___- ........Capacity--9-0-o-------- <br /> D;sposaf Field: Distance from nearest well---C-W.-Distance from f�.__-_-- <br /> tion------0_--.---.Distance to nearest lot line---,,S- ------ <br /> Number of lines---------- ------- Length!WA3 �--- of french 4@4 V' 57Ftlal --------- <br /> Type of filter maferial -------Depth of filter mater.7-----/0-- -------Total length---------- 5Eii_7_—, <br /> 3 . :_1 r--j- <br /> Seepage Pit: Distance to nearest well---------------------Disfance f f6m 46und`af ion--------------------Distance to nearest lot iine---------------- <br /> Number of pits------ -------- -----Lining material---------- ------------ ize <br /> D S' : D�ameter---------------------.Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-..----- material------------------------------------❑ - <br /> ---------------- ---- -- -------------------- P, <br /> Size: Diameter-------- <br /> .............................Depth -Liquid..C�'acify------------- ---------gals. <br /> Privy:' Distance from nearest well-----------------------_---____-.-------:-_: .-Distance from nearest building_---.--.--.---..-------------_..--------. �r <br /> ❑ Distance <br /> uilding-------------- --------------- ---------- <br /> Distance to nearest lot line-------- ---------------- ----------------=------------------------------------------ <br /> -----------------------------__------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe):---------IAI.......... .- -- ---------:SE W_I C----P,------- ------------ <br /> ------------------------------------- ------- -------------- -------------------------- -------------I---------------- ---------------------------------------- ------------------------------ ------------------------- <br /> ----------------------------:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------- --- ---------------------I---------------------------------­-------------------------------------------------:---------------------------------- -------------------------------------- I <br /> I hereby certify fha+ I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)..-A. <br /> I.. - --------------------------------------------- -------- -------------------- wrier or Contractor)- <br /> By:---------- ---------------------------------------- ----------------------------------------------- -----------(Title)------------------ -------- - -------- ----- - ------------ <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 /> — i <br /> APPLICATION ACCEPTED BY------- --------- ------------------------------------------------------------ DATE----- ------------------------------ <br /> REVIEWEDBY------------------------------- ­­------------ -----------------I--------I---------------------:---------------------------- DATE----- ------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------- ----------------------------------------------------- DATE----------------------------I----------------- ---------------------- <br /> 7- <br /> Alterations and/or recommendations:---J40—;P------- _M _ <br /> 7_ `WWA..... - -------- Ap---- -2---- <br /> --C5------ <br /> --------------- ---------------------------------------------- ............ ------- -----------------------------------------------­­-------­­­-----------------------------------------11-------------A-/< <br /> ---------- ------------------------ --------------­ -------- - --------------- ------------------------------- -- <br /> ---------------- ----------------------------------­ ­_ ---------------------------------- <br /> , <br /> -- - _� V&--- ---t----------------------------- <br /> - <br /> -------------------------------------------------- <br /> - <br /> ---------E -- --- ---- <br /> - --------- -- <br /> .............. ------------- ------ - -- ------ - ------------- - - --- ---- - --- --- ---- ------------------------------------------------------------------------------------------------------- <br /> FINAL INSP ION .... ... 5------------------------ <br /> Date-.------ ---------- _3 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,Calfftrnla.- Manteca,California Tracy,California <br /> r <br />