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FOR OFFICE USE: <br /> "a <br /> ........................ APPLICATION FOR SANITATION PERMIT Permit No. ....:�.L`r. •' / <br /> r /' <br /> ......................................................... (Complete in Duplicate) / <br /> ....."............................ <br /> ....................... p � Data Issued .7 <br /> ' This Parmit Ex ire$ 1 Yerr From Data issued <br /> ...................."I..... <br /> Application is hereby made to the .San Joaquin Local Health District for a permit to construct end install the work herein described. <br /> This application is made in compliance wi Count Ord' anc�. 54 .y � ��• Awa <br /> s JOB ADDRESS AND OCATION..... ' 4Grs--r +,.... <br /> c <br /> Phone.. ................... <br /> .���' ............. ......... ......... <br /> �3.f <br /> Owners Name-........ <br /> •• ..... <br /> 3..x,5.....h - -a�a- -.......... ..:........... ......... <br /> '•' Address...................... .............. <br /> `. <br /> .. <br /> Phone..� 9� <br /> ........ Ate• <br /> I <br /> � -L�x�+o, ........... 3- <br /> '• Contractors Name.................... ❑ Commercial ❑ Troller Court ❑ Motel ❑ Other ' <br /> ;,. lns+eElaiion will serve:" Residence Apar House <br /> r _ <br /> E� P <br /> Number of living units: .. Number of bedrooms fQ.. Number of baths ..�... Lot size ...7 X " `S.Q....•• ' <br /> Water Supply. Public system ❑ Community system ❑ <br /> Private Depth to Water Table, .;W. ft. <br /> 4 ; <br /> Y; Character of soil to a depth of 3 feet: Sand Gravel❑ Sa Now Construction: Yes 0 NolWay❑FHA/VA.Yes❑Hardpan <br /> is <br /> Previous Application Made: (if yes,date....................1 No <br /> �< TYPE OF INSTALLATION AND S?ECiFICATIONS: <br /> y` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> P >:-.. .............Mater?al............................................. <br /> .' Septic Tangy Distance from nearest well__,,,--.-....Distance from foundation capacity <br /> l�tNo. of�compartments..........................Size.......-.,..........---.........L�quld dap+n.....'sta.......tt <br /> t <br /> Disposal Field: Distance from nearest welL...b��.....Distan:e from foundation....../.A..r.....-:7stan[e to nearest lot line <br /> .......... <br /> Number of lin=s. ...-.......//.............. Length of each line.........a-C''-...........Vlridth of trench............ . <br /> t:l }: Total length...............JJ.D............1. <br /> �•;. Type of filter ,neterlal...../�DC:/.C..-..Depth of filter matenal....-../.. ..--.•••- gr_— Y, \� <br /> e th................................. <br /> I Seepage Pit: Distance to nearest wall"................. Distance from foundetion...........-.---....Distant tb nes�rdsf lot ne................ <br /> ❑ Number of pi+$......................Lining material_..............-.....Sizo: Diameter.............:......-. p <br /> �f• ..... � <br /> f Distance from nearest welL................Distance from foundation muter�al........................•••• pis. <br /> Cesspool: .Li uid Capacity...........................•4 C, <br /> Size: Diameter.....................................Depth.................................-....... q C <br /> a ❑ Distance from nearest building.......................................... <br /> r ............................... .. <br /> t Privy: Distance from nearest well.............. ', <br /> Distance to nearest lot line.............................. <br /> Remodeling and/ r,repairing (des ribe� �: ........ 1- <br /> � '�. .. ........................ ..... .. ...........�'� ............... <br /> N ..................... ..... ..... <br /> .........................................................pa <br /> i l hereby certify that 1 have proposed+his application and that the work will be done in accordance with San Joaquin nun � <br /> Health D• <br /> ordinances, State lays, and rules and regulations of the San Joaquin Local .strlct, <br /> ,i • r ........Ow nerand/or Contractor] <br /> ............. <br /> tr..................................................... + <br /> C.�.�.�t-c- ,........... <br /> ............(Ti+lei.......��._.".r..................... <br /> By: 12�'-*=. .,.......G...........�.,ni. <br /> ,^-c:::-............ <br /> y:.............. <br /> (Plot plan,slowing sire of lot, location rf syation to wells, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE:..................... <br /> : ,. <br /> APPLICATION ACCEPTED B .................................... ... .. . ................-........ <br /> ............ DATE::................................ <br /> ^ REVIEWED BY............................................._ DATE............................ ............................. <br /> i.y.. BUILDING PERMIT E55UE0.............................................................. . G"e`�• -. --...-...-.............................-................. <br /> t .....-t:'...........�r .............. <br /> ..............................i.�.�...... . <br /> Alterations end/or recommendations:................... ! •-' �..1.:�:_.� ..................--................................ <br /> .. ............................................................. <br /> ....................... ............ ...........'.................................. ................................... ' ......... ' ......_."...............-.................. ................................... <br /> Date.........' ........./. <br /> f................................... <br /> 1 <br /> FINAL INSPECTION BY:................ _ <br /> SAN J0,4QUIN LOCAL HEALTH DISTRICT <br /> 205 West 9th Srreel <br /> 124 e SlroeI <br /> Sycarner <br /> 300 Weff Oak Street T,acy,California <br /> 1601 E.Ffoxellen Ave. Men teen.Collfernia <br /> Led[,Callfarn la <br /> Stoc"on,California <br /> '�.�•,� C0 9 RCVICCD e•Se ]M :Z•'6] r.P.0 a. - <br />