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- - - ��Z <br /> ---.__----_......................................... APPLICATION FOR SANITATION P,C � �r�T ermlt Nor«:, .. II// <br /> .................................-------------------- (Complete in Duplicate) 1 $ a .T l� ate Issued ._____�,+`--$-Z <br /> ..................................................... This Permit Expires 1 Year From Date Issue <br /> Spplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> lllaee�is application isZLOCATION. <br /> �in pliance with County Ordinance No. 549. E� °�►HLCA, <br /> . f <br /> JOB ADDRESS �1_...F.Ran[.__ }� ..� o_.-_d!�----, NIP/ ! ---- ..... .r> <br /> Owner's Name....... .-.... ...................................-- -- Phone... <br /> Address---.4 <br /> Contractor's Name.....311 C?Qy � t�T 1. ....A� V I C 1 ........._.. Phone..........._..___..... .._.. <br /> Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _.'__ Number of bedrooms-. Number of baths Lot sire ....... £:.__.. «��...._........._ <br /> Water Supply: Public system ❑ Community system ❑ Private Zj D h To Water Table 3 ft. Ci A u <br /> Character of soil to a depth of 3 fest $entGravel ❑ Sandy LoamClay Loam Clay❑ A erdpen ❑ <br /> Previous Application Mads•. (if yes,date--...___---_------) No ®-'New Con lion: Yes ®-No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: b\ <br /> No septic tank or cesspool permitted if blit sewer is available wWm'200 fest.) Capacity.... <br /> Septic ank: NoDistance tom art nearest <br /> a}st_welL-_5_.--::_ Distance f foundetio _ .-.-P__Mis I-_: <br /> ( Pti uP Pin Pu /; I' <br /> 1Y <br /> P �"' �-x-- --`�.S-.Liquid de fh---------- ._lS.S-.`..��-.:.. <br /> Disposal Field: Distance from nearest welL.Jr r!�...._Distance from foundation_.._) __..Die ante to nearest lot line... N <br /> Number of lines--------.._/-_....-_------.._._Length of each line.....!�.�._ASNDWidth oftrench...... .. ............34-.. <br /> Type of filter material____,RO..�i_Depth of filter materiel— �L._.......Total length---------'j�_..�,1 <br /> Seepage Pit: Distance to nearest welL..._.._............Distance from foundatlon..�___.__.L__Distance to nearest lot line.__............. <br /> ❑ Number of pits------------------_Lining material.......-.............Size: Diameter-..........-----------Depth-----------.................... <br /> Cesspool: Distance from nearest well--_-..-Distance from foundation............._.....Lining material..........._.._.._ <br /> ❑ Size: Diameter......._------------_........._.-Depth.....--.-------_--_--------.-_._-_-__._..Liquid Capacity-.-.__...._........_._gals. <br /> 4rivy: Distance from nearest well............------...............-..............Distance from nearest building__._.__.__-. <br /> ❑ Distance to nearest lot line.......'............................-------------.._....._------- <br /> Remodeling and/or repairing describe :_.._... 4r n <br /> ..---------_._..__.. .- '- '- -----='-------- ------'--___..__1`l_---- __.-Y---. -------------------------------- <br /> 4L <br /> - ----- --- --'-------- <br /> Q�(4y�!• <br /> ---------wkojaby..5-------- --- LC ILLtK....?Ri5nfCkt <br /> I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou <br /> ordinances, to laws, and rules and regulations of the S H R O <br /> P-- <br /> to "ISE-- P� <br /> .......................... f _ to <br /> '--- ---•----- (Owner end/or Contractor) <br /> B - - - --- - - --- - .......................'--......--------.................- ------­------- ---------------- <br /> Of plan, showing size of W, location of system in relation to walk, buildings, etc., can be placed on reverts side). <br /> FOR DEPARTMENT USE ONLY �f <br /> APPLICATION ACCEPTED BY------ --- -------- __------------------- - DATE.- --r :................ <br /> REVIEWEDBY..................._......-........ -----------•- - —_-— - __ _—_ DAM................_._.._... -------- <br /> BUILDINGPERMIT ISSUED...........-.............._--------............. ...................... ........ DATE........._......-................--..................... <br /> Alterations and/or recommendations reccoJmmenndatiions:._.------------------_T..C....0.--.._..._.....___-_ ----._-__.._--_—...._.... <br /> _._._... <br /> ........... -----------.,�...-t�1-,Fz�-•--- - - " — <br /> -- '.- --- --- "...............niRkp?--.---- -- <br /> ri _— — - ............... <br /> ......3-n.746.n6.3..........�i oCl S......f kIEL.52---�0-_-------�--------.1t—4AV ..:Q— t�.._ —. -.Tx.FLC..:..................-- <br /> - -- -- - - --- _.--..----•------------------------- --------------------------------------- - <br /> -- -_...------ •--•----��-----``------•----------------------- <br /> FINAL INSP lON BY:.. .. ._ Date ......J.. �? r -_--_----_...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West oak Saeet "124 Sycarnare Street 205 Wert 9th Strest <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5.62 ATLAS <br />