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• .,eFOR OFFICE USE: . <br /> ,,+APPLICATION FOR SANITATION PERMIT Permit No. .. �F�o <br /> V_ (Complete in Duplicate) Date Issued ..� 4 <br /> ............------------------------------------ .------- IPS This Permit Expires 1 Year From Date Issuedli <br /> Application is hereby made to the SEn'Joaquin Local Health District for a permit to construct and install the work herein described. <br /> The application is mad i compliancith County Ordinance No. 549. 3 j4� t 2S-Zap_oL ELO� <br /> i <br /> 3� S SIDS ZO <br /> JOB ADDRESS AND L ATIO -A.BR.O..C.W&.:........o'9�c .. -:. o.. w�y.....L...............'.-. <br /> cs, <br /> ( Owners Name...... ,._ .�.�.�p7Q <br /> .�,..t� � .... - ...... `...... ... <br /> Phone..............._................. <br /> L.-........ jlpQL1 ........ ......_...... <br /> Address.-- <br /> Contractor's Name....CAACt1.6 Wit...........-------...................................--.............................. ..---_... Phone............................. .... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: .(II--- Umber of bedroom---- Number of baths r•. Lot size .Jl' R.F..�...:...... <br /> Water Supply: Public system ❑• mmunity system ElPrivate Depth to Water Table2S. ft. <br /> Character of soil to a depth of?fe't, Sand 2y--Gravel ❑ Sandy Loam El Clay Loam❑ Clay❑�Adobe❑ Hardpan [IPrevious Applieefion Made: (If yesvpte....................I No j;/h ew Construction: Yes J&,No ❑ FHA/VA: Yes ❑ Na.�3 <br /> >i <br /> _ TYPE OF.INSTALLATION AND Sf IFICATIONS: �. <br /> - <br /> -(No septic Tank or cesspoo`��r tted'if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from "Arest well....---.........Distance from foundation...................Material......._......_.....--..�±X'r........ <br /> ❑ No. of compartn,ants........----.............Size.-----....................-.Liquid depth..........................Capacity-......--�---- <br /> Fi w <br /> Disposal. Id:e�r,Distanee..1gA ' 'rest well..-'r�..C10.Distance from foundatioA.*.''/i�9...'."�Di3tMcrf6*tearest to linej�r�.. t;y� <br /> Number of lines ` ��.y.......Length of each line....-. .Q-.-..._...Width of frinch.......3& <br /> I Type of filer ma+arial..A0.CX...Depth of filter maferial. /?f ......Totapl length...............:. d.:_...... y <br /> Seepage Pit: Distance to nearest well... .Q.O `Distance from foundetion...l.. i3tSRce-4o dearest lotjine..5........... <br /> Number of pits....................Lining rr%+eria .Vl.C.K Size:lDiaiFe'16)(90t.I...1 th...... - (^p <br /> Cesspool: Distance from nearest well................dDistance frdm4pyndation--------------......Lining mat Bial..------.................._......... <br /> . <br /> ❑ Size: Diameter......__•..................`-.`f.Depth-----------`.........._.....----......--....Liquid Capacity... <br /> ,.j.: - <br /> .........- .--..gals. p <br /> Privy: Distance from nearest well.......ff..... <br /> /..... :a from nearesf.building.:..... -4- <br /> 0, D,eance to••naerest to IiAaa001f------------...................-----..........-_.1...........-..............._..........l._...._..----------------- ; <br /> 416, <br /> Remodeling and/or repairing (describe):..._....................'-----------------------------------.......;------..._.....------------..... -----------------------...:...---- <br /> ....................-...-.............................................._............................1............................................................................................................ - y <br /> `----------------........................------.................................................... .•...........................-.................---.................---................-.............--------- <br /> -- <br /> t ......................--------=--------------------`------------.---------:------------..............:---........................----- <br /> t I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County, <br /> j ordinances, St ws,pird7rule, and re ations of the San Joaquin Local Health District. j <br /> ` (Signed)...... ... ..... „ .. .. (Owner and/or Contractor) <br /> L - Y Y. . .. _. Zr <br /> By' -- <br /> ----- ---- - <br /> ----- -._-------- :A °------ ---------- �---":.. � .�tleJ. -..�^- --.......... ...................... ,• <br /> i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t.y� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----..fTj <br /> .. _--1 ................... ..'- .......................................... DATE -Jg =,Ad_7L..._----I__......... <br /> REVIEWEDBY..........................................-------- -----------------------....................--- ..............._ DATE---- -.......--------........................ <br /> BUILDING.PERMIT ISSUER...........:...................----- ------ ........ ............... ......... DATE..... .....---------- ------- ----------..... <br /> Altrafions end/or recommendations:?--- !6� ..:+ta7.11.1R.1�.ED."-e$�F..o$E:..:...�"-`/:A��::-:lfV&P.�.Tl.lF1.�L......... <br /> ------............._w1.1i.....InY---.ftl,MAsSCRAIT..----F1l T:.,. 1IYSP. .tLLtn1....../'Rog;1Pr.5........oa! ..., <br /> ......................... .. <br /> ....................... <br /> .....---- --- ,- - .................................. <br /> .......... <br /> RX <br /> - ..........- .... . ............... ................. <br /> - -.... .._....... -............... ..... . .._...-....... .... .. _._.._....- - - - ............. -.............. <br /> r FINAL INSPECT ON /� .. .... .... -- Date...........ZZ_"/i�.-- " ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,Celifomla Trow,California <br />