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FOR OFFICE USE: <br /> ----------------- .......... -------------------- <br /> ------------ --- <br /> -------------------_..............._ --------- ..... ------------- APPLICATION FOR 'SANITATION PERMIT Permit No. <br /> ------------------ - ............ (Complete4n Duplicate) <br /> This Permit Ex fres t Year From Date Issued 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 compliance ith County Ordinance No. 549. j'hTGf3 r <br /> i <br /> r <br /> JOB ADDRESS AND LOCATIO <br /> Owner's Name----------------------------- -----------=-VA N---Ry •---- <br /> - - -- ----- ------ ------------------------------------------- Phone------------------------------------ <br /> Address-------------------------� --••� AAAM,F_D/ - <br /> Contractor's Name------ --------OW E� Phone <br /> ------ ----------- ------- ------- -- .......---• ,. <br /> Installation will serve: Residence ®/partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El <br /> � AcT �----- <br /> Number of living units: _�_.___ Number of bedrooms 3__- Number of baths --____ Lot size __ _. __. -_ -_---.--.--_ <br /> Water Supply: Public system ❑ CommggMyuuniity� to-1system 0 Private��epth _ater Table%_d _ ft <br /> Character of soil to a depth of 3 feet- Scvfd H ,❑ and Loam ❑"' aayy'L'oam ❑ .Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--...... I No New Construction: Yes Er No ❑ FHA/VA: Yes 2' No ❑ <br /> TYPE OF INSTALLATION,AND SPECIFICATIONS:-- " <br /> (No septic tank or cesspool permitted'if public sewer is available-within-206feet.) <br /> t. <br /> Sepfic` 4'. Distance from nearest well-----.ar------Distance-.froi foundation____.A�____"__.M�a,teria! -- ---- <br /> .CT>=-- <br /> No. of compartme>s._.-_.. —_^_ -Size" x.l10._X-_ ___-_Liquid de th__[Q_.._..--- ._-.----Capacity �ti7�C� C`„ <br /> Disposal Field: Distance from neaiest' e{I' `,i' ._Distance from foundation---- <br /> -14__________Distance to nearest lot line____ _. <br /> Number of lines -_._____ _._ ` <br /> ----- <br /> .--Number --------Length of eac#, line_--��`? .__..----��:�Width of trench--��------------- r ---- 'a <br /> Type df.f-Iter materiar�-: i._Depth of filter material--__._P______Total length--------------- <br /> Seepage <br /> �.� , ' a r <br /> Seepage Pit: Distance to nearest wei0. ................Distance`from foundation---------------------.Distance to nearest lot line._._-.-__..__- s <br /> ❑ Number of pits``--------1�...Lining material---------------------- Size: Diameter--- <br /> --,•----------------Depth--------------------------__-•-, �` 1 <br /> Cesspool: Distance from nearest wel�________________Distance from foundation---:_.______.--_- - Lining material_..._-__:__....___._ -__ - <br /> •,� - #►+ <br /> ❑' P ------------------------------------------- ----- Liquid'Capacity------------- -------------gals' 1 <br /> Size.: Diameter- -_�;__.--: _---- ------------ --Dept - <br /> Privy: Distance from nearest well................. ___.._._._____ Distance from,:nearest building-------------------_._-_-_________-_-_ <br /> ❑ Distance to nearest lot <br /> --------------------------------- <br /> Remodeling and/oit Pe iring (describe): z�n + <br /> ----------------••--------•--�-&------- ----------------- ---------- ---V`�---------------------------------------- - --- ----- --- •------ -------------- <br /> ------------------------------ <br /> --------------------` -=�-------------------•------------ ------- -- }f--._.._.___ _. ______. - ----------------- <br /> ---------- <br /> - i <br /> y --- -- <br /> --__.-_..-,_-___- ------------------- <br /> __---------- <br /> _______ _ s J 3 �p{.•�r,�'. <br /> - 34] <br /> I hereby c rtify that (';have prepared this application and that the work will be`done in accordance with San Joaquin County <br /> ordinances, St a laws, and µi n : . gulations of the San Joaquin-Local Health District.: <br />- <br /> .(Signed)-. -- - --- ---- � --- -",- --- --:`--- - - -- -- --- -------- ---------_ <br /> -------- - --•- - Owner and/or Conracfor} _. <br /> BY:---- I Title <br /> ..-•------------------- -------------------- - ,..... -- <br /> (Plot plan, showing size of lot, lbcation`of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -APPLICATION ACCEPTED 4- -- ----------=f ------- <br /> REVIEWED <br /> BY-------------------------------- ----------------------------------------------------------- ------------------------------ DATE------- <br /> BUILDING PERMIT ISSUED---------- {---------------------------------------------_- ----------------------------------------------- DATE--------- --------------------- .........•-••-------- <br /> Alterations and/or recommendations-................. -------------------- ------------------------------------------ ----------------------------------------------- <br /> -----------­­--------------------- <br /> -----------•------------------------- ---------------------- <br /> I <br /> `:: =_`_ I f"i-� Mei -, <br /> I I <br /> w <br /> -------------------------- ------- <br /> FINAL INSPEC Y:- - ----- ---- • Date---._-.__;_.... } <br /> " SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> V. <br /> 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Strbet,. 205 West 91h Street ; ? <br /> Uockton,California <br /> Lodi. California Manteca, California'' Tracy,California <br /> E.H.9 2M 1-b7 Vanguard Press � ,.�- Y �' <br />