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t,� rurc urri�c uat: <br /> II } <br /> L_:------------------------------ -------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. . _�-i _ ... <br /> ----------------- ------------------------- ------ <br /> -------- ---------------------------------- ------ (Complete-in Duplicate) Date Issued <br /> I ` This Permit Expires 1 Year From Date Issued <br /> v 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. <br /> ' JOB ADDft1=55 AND LOCATIONL� a <br /> -------------- y 3� <br /> Owner's Name---A_`...FI-----W,C7A -------------------------------------------------- -----------------------------------------. Phone- - -- --- <br /> +t <br /> ---------` - <br /> Address__ �' '� -- 1 <br /> I <br /> Contractor's Name /` , :_ -{.� i Phone..- <br /> i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> k Number of living units: .. Number of bedrooms _ Number of baths _ Lot size _.__ _ ____________________ <br /> Water Supply: Public system ❑ Community system ❑ Private$6 Depth to Water Table 1 t <br /> ti Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam A Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_..__..._- 1 No� New Construction: Yes ❑ No FHA/VA: Yes E] No)K <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ❑� Septic <br /> i Distance from nearest well-___.___________Distance from foundation___________________Material__.____.___._.._---___-__._.__-._-_._________--Se tic Tank � � <br /> P <br /> # t No. of compartments--------•---------- ___Size--------------------------------Liquid depth--- --- - --------Capacity-------------- <br /> � Distance <br /> , 't -- - . ___.-�.-.-..-__-_._•. <br /> Disposal Field: le � earestwl4 ----- � trfoundation Distance to nearest lot line-__ <br /> ----------------- <br /> Number of � Length of each line. Width of trench •_ <br /> Type of Hier material-- __..__Depth of filter material---- ---------- Total length____`. _ __ ______________________ <br /> - <br /> Seepage Pit: Distance to nearest well... ----------- <br /> _______Distance from foundation__. .i _______.Di an a to nearest lot line__ <br /> Number of its. g i # _. Size: Diameter___ t <br /> p _Limn material ' ------Dept <br /> Distance from nearest well ________________Distance from foundation._ ------------- _.Lining material------.--------._.-________________._. <br /> i ❑ Size: Diameter- -- -------------- ---- ----------Dapth--------------- -------------- ------ -------------Liquid Capacity_----------- -------------gals. <br /> Privy: Distance from nearest well--------------.----------------------------------Distance from nearest building_-_-._-__.____-_____----__-----_--___._. <br /> f ❑ Distance to nearest lot line ----- ------------ --------------------------- --------------..--•-----------------------------------•------------------------------------ C <br /> 04 <br /> Remodeling and/or repairing (describe) = ---•-- -----•------• ------•---•---•------------------------------- 0- <br /> I1 _ ___ ____________________________ _______________--___.________-_____-__________-____-__-___________________________ ___-_-- -_--______________._______._.___________.________-__-______.____________________-. <br /> I hereby certify t I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I s, nd ru' reg,ations of the San oaquin Local Health District. <br /> les and <br /> 1 F <br /> ' F �' .- ---: Owner and/or Contractor) 4 <br /> (Signed)--------------- ,r �_: � +�€i &..i l <br /> +-� 6Y= :---------- -------E `�. - {Title) - - <br /> t (Plot plan, showing size clot, location of system i relationrto wells, buildings, etc., can be pled on reverse'side). <br /> FOR DEPARTMENT USE ONLY <br /> s -------------------- -------------------- - --- ---------- DATE-------WK7CV-_........ ------------------...... <br /> � APPLICATION ACCEPTED B' ______ _ _ _______�`__.__--_.. -- <br /> REVIEWEDBY------------------ ---- -_------------- -------------------------------------------------------------- DATE------ -------------------------------------•------------- <br /> BUILDINGPERMIT'ISSUE ---- ----------------- --------------------•----- ----------------------------------------------- DATE----- ----------------­--------------------I----- -------- <br /> Alterations and/or recommendations:----- ------------ -------------- ---- ------------- --------------------------------------------------------------------------------------------- <br /> -------- <br /> ------------------__------------------------------------------------------------------------ <br /> -------------------------------------- <br /> ----------------- <br /> --------------------•----------------------------------- ----- <br /> - <br /> ------ ------------------ - --------------------- -- <br /> -- ---------------------- ----------------- ------------------------ ---------------------------------------------- -------------------------------------------------------- --------- ---- <br /> ---- ---------------------------- <br /> -------------------------------- <br /> --- --------------------------------- --- <br /> ---------------------------- --------- <br /> -------------------------- <br /> rw h <br /> FINAL INSPECTION ItI.Al IN <br /> Date � 1��7r1 <br /> S JOAQUIN LOCAL HEALTH DISTRICT <br /> I 1801 E.Hazelton AV*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,CcEifornia Lodi, California Manteca,California Tracy,California <br /> c.H.9 2M 1-67 Vanguard Press <br /> I <br />