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f FUROFFICE USE: <br /> a , <br /> -------------------------------------------------- <br />. ---------------------...__..----------------- .__--..__'I_.-.. APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> (Comple;e•in Duplicate) <br /> ---" --- ------- -------------------­- <br /> ------ -- --- I� -- <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Applicafion-is W Aeby maae�o the San Joaquin Local Health District for a permit to construct and install the o k herein described. <br /> I This application" is.made in Compliance with County Ordinance No. 549. _ 23e7 r2S <br /> J08 ADDRESS g b LOCATION � - �� •' - Un <br /> TION. YRl./�:Owners Name._ ` ' =I�- :�:.. �' _l _�_ - eAddress. - n_- ----i---------•----•----------- <br /> Phan _ <br /> ---- j f- <br /> i. Contractor's <br /> ------ Phone`-s- <br /> ----------- - <br /> ----------------- <br /> Installation will serve: Residence Apartment House ❑ Comme'rcial 1 -Trailer"-Court, Motel j <br /> g � • E❑ ; ❑ �] Other ❑ <br /> Water Supply: Public system Number of bedroom's ___ __-_ Number'of baths r1--Lot.size ____ . a __+ --------------------_---- <br /> Number of living units ____ <br /> m Co munit s st a <br /> ❑ Private ❑ Depth.to Water Table __..._ _ ft/,j <br /> II q f , -'/ <br /> Character of soil to a depth of 3 feet. $rand 'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑; 'Adobe ❑ Hardpan ❑ <br /> Previous Application Made: "I�{lf yes,date...... } No New Construction: Yes o ❑ FHA/,VA: Yes e-'No ❑ <br /> TYPE AND SPECIFICATIONS: <br /> _(No <br /> (Noie +c-t Alk-oor c i pool permitt�edLif pubiic_sew.eF-is available.within.200 feet.) j <br /> Septi anka Distance {hfrom nearest well Dista e from fou dation � __.____ at}e '`al - Z L7.5 <br /> iVo...o.f_com artmen.fis... ,- <br /> `___. it p � --Y: :- =.Size _ - x �rquid depth_./, '7�...n f Capacity .1R.7OC7 1 <br /> Dis osa.Field: Distance from nearest well-_C,._ . <br /> p { 11i�_D;stance from foundation___--'�____.__,,,�iStamce to nearest I I'n � •r <br /> x _ Qr <br /> Number of lines --------Z ~ ._. ._ ____ Length of each line__ ._ � 7----- I/idth of trench. -____:_.. ,I <br /> Type of filter material_- Depth of filter material-`.-. - _ l Total len `th------------------------------------------- <br /> p <br /> --..__ ...._ <br /> g -- -------- ---- <br /> - s <br /> Seepage Pit: Distance to nearest well__-_.- Distance from foundation_______________ _ pistance,to nearest lot line----------------- <br /> !"!Depth <br /> .__...__-__... <br /> ❑ Number of its ----------------Linin material------------- •'.! l,' <br /> } p g Size:' Diameter - Depth----- -------- ----------------- <br /> from nearesf well _______________Distance from foundatio_._.__....__.__--Lining material___.__-..._______.______--._._.._.. <br /> Cesspool: Distance meter_ - Death - '.Li 'u€d Capacity <br /> A <br /> ❑ Size: Dia, <br /> �. .. q ------------- -------------gals <br /> Privy: Distance from nearest wiO.............r-----------------------------------Distance from nearest buildin ' <br /> ig•-'•:- ------ <br /> El „. �D.istance to-nearest lot Ime"- ' - I <br /> Remodeling anildfor repairin'gl[(describe)_------------- <br /> --------------------------------------- <br /> C <br /> ------------------- <br /> _______ -----------------------------i_._--_._____.__._____._._____._----______�_____._ ____.._________.___ _ <br /> -------------- 1� - ` --------------------------------------------------------------- <br /> r <br /> -------------------------- F i-- -- ---------------- - --------- <br /> I hereby certify that 1 have pre;pared'fhis ap-p ica#.ion_and�that the wonk_will_be-doneiin accordance with San Joaquin County <br /> ordinances, State laws, and rules.ti nd%regulafions of the San Joaquin Local Health Distric+. 1 <br /> /,_ <br /> ---------- - - fit_ .. --. L ---------------- <br /> (Signed) � V f �`/ P� e j _ C r�t ) <br /> r _ <br /> : ' <br /> B I - ---- -------- -- ':- .--(Owngr and/or o ractar <br /> 3 I( - t <br /> Y• _ _ r dh r_ — (Title) ._ <br /> (Plot plan, showing siz of bt,;�icatio nj of sy an tela+ion'ta wyells; buildings;etc. can i;e {ilaced on reverse side.m� " """'"""�"'� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION':. ACCEPTED BY_:_.__" -1 3 + -- t <br /> �l l " <br /> ------ ------------------=------"-` =----- DATE <br /> REVIEWED B ` ( i._._ ...._._,. _ - " <br /> --------•-'s--'�--------: DATE--------------------------------•------�-- " <br /> BUILDING. PERMIT ISSUED-411- i �_.�_- -.--------- � <br /> ----- - DATE- <br /> -- - ---- ------- ----------- ---------- ---- - <br /> ----- -- <br /> Alterations and/or recommendations:. Ry.. D_.-.-LtO_�14t1?RNH.t __.___.__-,_ <br /> --- -- - <br /> - --------- l . . ��._ _ <br /> _. <br /> ------------------------------ --------------- <br /> - ----------- --------- - ---------- <br /> --- -------------- <br /> FINAL INSPECTIO <br /> �.� 7777./. _ -1sK --------------- <br /> SAN JOAQUIN LOCAL, HEALTH DISTRICT <br /> 1501 E.ffasolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 5locklon,California I Lodi, California Manteca,CaliforniaTracy,California # <br /> E.H.9 2M 1-67 Vanguard Press <br />