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FOR OFFICE <br /> - USE:- <br /> '-3G uAPPLICATION FQR` SANITATION PERMIT <br /> = hermit No. <br /> ---------------------- - / ---- Com lete-in <br /> Duplicate) <br /> Date issued <br /> ..---- --- ---- ------------ -- <br /> This Permit Expires 1 Year From Datd 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 with County Ordinance No. 549. i <br /> JOB ADDRESS AND LOCATION-Z--------------- - -- ------- --- --- ---- - ---------- 0-a --- ��'.�1�.---------------� -------- <br /> ---- <br /> ---------- . Phone------------------------------------ <br /> Owner's Name----- gam <br /> / U/ ,/ ���• ° = �i' ----------- ---•------------------------------------ <br /> -.--- <br /> Address-------- <br /> ----------------- ------- - ---------------------•-------------------• Phone---_-- ---------•------ <br /> ------------ <br /> Contractors Name------ -- p-��-_------ 401D --Gam__-' - <br /> Installation will serve: Residence 59,­i°Cpartment House I] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -� <br /> Number of living units: -/.. Number of bedrooms _ , <br /> _._._ Number of baths�._ Lot size ``-�®__ APZ7----------------- -- <br /> Water Supply: Public system ❑ Community system ❑ ,Private [4,_�epth to Water Table4?A ft <br /> i <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [�ardpan ❑ <br /> Previous Application Made: [If yes,date-------.----------- j No [ New Construction: Yes gi—No ❑ FHA/VA: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> { ose tic tank cesspool lP permitted P� <br /> sewer is available within 200 feet.} sF+ �►° llC%Se tic Tank: Distance from nearest el � tance•from fo4ndation__ Q___... Materia <br /> No. of compartments_ �..................Size.�y/&- .-'VX�_iiquid depth_ .X... ........Capacity`2-----_- <br /> Disposal Field: Distance from nearest well__z4"Q_/��eh <br /> Distance from foundation_.Z _.-....Distance to nearest lot line--+�..__ --. <br /> Number of lines ----v_��___-..._�_ gth of each line-. 9Q-'___.__�_..-.Width oftrench_�_�__-__�-------- --------Type of filter material! epth of filter material---ZcF"_�Total length_-l_ �--------------------- <br /> o . <br /> Seepage Pit: Distance to nearest well_.�.00-.-__Distance fro foun ation_--filJ__d_-.___.Distance to nearest lot line_.ar_--_._- <br /> �� Number of pits-_-v`L--- ------Lining materia_ Q Size: Diameter___t .___Depth_..r2 �_�______________ � ` <br /> i <br /> Cesspool: Distance from nearest well ----------------Distance from foundation_...------------- ..Lining material-------------------------------------- <br /> El Size: Diameter- - ----- -------- ----------------Depth----- -------------------- ------------- Liquid Capacity- ---------- ------- ----gals. <br /> Privy: Distance from nearest well-------...............!_-----------------.--------Distance from nearest building--------------------------------_____---._. <br /> ❑ Distance to nearest lot line -------- -----------------------=------------------------------------------ --- --------------------------------------------- <br /> Remodeling and/or repairing (describe):--- �4_zpl,..... ---- ---------------------------•-•----------------- <br /> ---------- ------------- ------------ ------------------- ---------------------------------------- --------------------------------------------------------- ------- ---- ------- <br /> I hereby certify that I have prepared this application and that the 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) =�G � -- ------ ---- -----------•-- ------ ----- ------- � or Contractor) <br /> ' Title <br /> By•-------------------------------------------------------- ------------------------------ <br /> { 1 <br /> (Plot plan, showing size of lot, location of sy min relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY----------�r,---------------------------'------ -- ------------------------- -------------- DATE----- -_ 9-_ ---------------------- <br /> o' REVIEWED BY---------------------------------------- ---- --- -------- --------------- ---- -------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED--------------- = =------- – DATE------------------- <br /> Alterations and/or recommendations:... .' 3_�� --- - <br /> ---------------------------------- ----------------------------------------------- ---------- <br /> Ips <br /> FINAL INSPECTION BY: 4'!1= ._r...1�1 -' QDate'-V .----------- <br /> SAN JOAQUIN!"LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street <br /> l <br /> 9 2M 1.67 Vanguard Press <br /> Stockton,California Lodi. California Manteca,California Tracy, California <br /> - <br /> r <br />