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,N <br /> FOR OFFICE USE: , <br /> ...........:.'..• JG. Permit No. ._//13 <br /> .._..,_..._._...__./f/."`Z­ <br /> _,r ._ APPLICATION FQR SANITATION PERMIT L s9 p <br /> (Complete in Duplicate) Date Issued <br /> ri `..._-....-........ ................... /........._.-_... <br /> ;. -_................................._...._......_..... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health,District for a permit to construct and install the work he <br /> described. <br /> This application is made in compliance with County Ordinance No. 544, <br /> ?. _. <br /> JOB ADDRESS AND LOCATION....Z .'S�. ....... fJrLEj✓Ch.'......C.N".. .......i ........._..........._.... <br /> ' .......... Phone <br /> Phone..._.._. <br /> OvmersName... T ...........__.............................. ... <br /> ......._....._. <br /> Address................._l.H.. -7------------ <br /> T._. ST.ra^>w�ON..............._---.............._.__._....._....._....__.. _ <br /> ' 4 <br /> 9 <br /> Contractor's Name._s�/�.2/�./.Jtl.....,/13�C ........................................................................................ Phone/tt2.Fr <br /> Installs±ion win serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ z v <br /> .. ' _�: ", <br /> Number of living units:._ .. Number of bedrooms...I—Number of baths ..(.... Lot size _..5�........J:.l.�i� I <br /> Private Depth to Wafer Table :....... ft. <br /> an <br /> Water Svaply: Public system Community, system- ❑ P - <br /> g Chera*tvr of soil to a depth of 3 feet: Sand❑ Grovel❑ Sandy Loam CI Clay Loom C Clay❑ AdpbeA 131 NO Q <br /> Previous Applicafior. Made: (if yes,date .. ........I No� New Construction: Yes ❑ Nog FHA/VA: Yes No�,[ ,1 <br /> TYPEOF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted if public sourer is available within 200 fe t) - i'-. <br /> ., Material ......_. . <br /> Septic Tank: Distance !:om nearest well......... .. .Distanco from foundation Ce era - - -• <br /> f ❑ No. of compartments ....... ........ ....Sim.__.._......... .......... Liquid depth .. P y <br /> Disposal Field: Dislence from nearest well..... Distance from foundation......._..... .Distance to nearest lot cane ..._..... , <br /> P s <br /> F °F ❑ Number of lines.......... ....................Length of each line_.............__._- Y/idth of trench .. <br /> Type of filter material.........._...........Depfh of filter material....._=_..i-. Total length 1' <br /> t, Seepnge Pit: Distance to nearest we'L..�/.Q-N ....Disfaoee from fa undation.J'.C?.-:.- Distance Io neerosf for II <br /> tJur:mbel o pits.......(.......... Lining maierial_gO.4n---..Size• �iarnetor......u3 . /epth <br /> . . t _ .�•• <br /> min. male lel } I <br /> Cesspool: Distance from nearest weli. ........_....D Distance from n- ,` - g - els. <br /> 1 <br /> r ❑ Sze: Diameter..................... ............Depth... <br /> .. •- Llgwa Cape city...... 9 <br /> - _ 11� 1 from. neon st.bwld'mc....:_...... :..._ <br /> Privy: Distance from neareaf well......_ <br /> ❑ Distance 4o nearest lot line... -.............. <br /> _ __. ._... <br /> Remodeling end/or rupalring (describe):... <br /> ... <br /> . dLL........zv....... Y./ST!,N__5`•^.. isj _ _ <br /> - - ....._....._._.._.__"_.................._.... - _ <br /> ................. ___. <br /> I hereby certify that 1 have prepared this app,-icafion and'ihaf tho work will be dens in accordance with Son Joaquin Coisety <br /> ordinances. State flaws- and rules and regulations of the San Joaquin Local Health District. <br /> sCl•.�i_._ Gini+ ,- n".u'� ..4'`r"'�'.: .. ............__..........•...-. ( nor and/or C.ontredx)D <br /> (Signed) dla ... _V —.. -- <br /> ,�)� � ..s.._ ......................... ............(T• J... <br /> . By._._ "_. Y,.z_..:ry <br /> p, (Plot plan,.shoving siu of lot, loca4io of s stem m illation to welts, buildings, eta, can be placed on reverse side) -- i- <br /> FOR DEPARTMENT USE ONLY <br /> - ,. Ih•L--- ----------- --------- <br /> APPLICATION <br /> _. �. .. <br /> - DATE_ 41 yam G� <br /> ' APPLICATION ACCEPTED BY.j__ .-_. DATE... --------- <br /> fy' - ................_.. ....... <br /> REVIEWED BY..... ._.__....._................ .......'.. ..._.. DATE <br /> - BUILDING PERMIT ISSUED ---- ."••"'•-------•••'- - <br /> g ................. _ <br /> . :?.... ....... <br /> ,e Alterations and nr r commendations• a �� � ...-�"'F� ,-../f..� <br /> _.. <br /> .................._............... ... <br /> - __.. <br /> ., ....._...._._................................._. ........ .., .... <br /> ............................ <br /> - jQrP./�er.. Date...........�� d�..../ ..... . ..... c <br /> 1 FINAL INSPECTION BY:....... ..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 e.Xeullen Arc. Soo Wart Oak Snnl 124 SYmmon 51m1 los'Wo1 91h sil_f <br /> -y" Ledl,California Menlna,Calllernla Twry,Calller•'a <br /> Ped,lon,Callfernla <br /> --�. rc v nw,am•-sa aw a=c.n r_r.c9. <br />