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�'T Permit No._................................ __..._._---- APoLICATION FOR SANITATION PERh _ ��.. �-� <br /> -__....._..._. ............................... ._....... •�... (Complete in Duplicate) <br /> — Date Issued ...�/ �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 ago install the work herein described. <br /> This application is made in compliance with County Ordinance No 549 <br /> ''//,� J <br /> JOB ADDRESS AND LOCATION._UV ` F�TNRnP <br /> VV rn ::Es,�vpk --I3`�.. � .�..�? R.Lv:E. ......... <br /> _ Owner's Name..........TD-D- -----1 R I-���......(fLL1e....:.......................................................... Phone..........---...........----... <br /> Address .`?_ .. .)...........F.._...1 -�-----5�--- .....r (�. F- f3 �F?i ............................................ - .-.. <br /> Contractor's Name........0 Uw.N GP,. ................ Phone................................. <br /> — Installation will serve: Residence ❑ Apartment House ❑ CommercialTrailer Cdurt ❑ Motel ❑ Other ❑ ojft <br /> Number of living units: .....- Number of bedrooms—. Number of aths . Lot size ..../4!r� ­1911G.F ..................... <br /> Water Supply: Public system ❑ Community system [I Private Q� L.De th To Water table ...1.. ft. <br /> Character atsoil to a depth of 3 feet: Send 93"`Grevel ❑ Sandy Loom <br /> Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous AppYic+)tiorl-Made: (If yes date...__-..___....) No II� New Cons ruction: YasNo ❑ FHA/VA: Yes C] No E <br /> .. TYPE OF 7IJSTAL1ATL0R-4ND SPEC <br /> JFICATIONS: <br /> (No septic tank or c`e3spoaJ�ermitted if public ewar is available within200_fee!) <br /> P _ 1P-------moferial...FC17.I!1t e2.).............. <br /> $e tic T nk: Distance from nearest�v el _. Distance m fclundation.... <br /> No. of compartments._-.... .` .�Siz --.. .....x.w�....Liquid depth.....------Capacity--.�.�.�..f. ... <br /> Disposal Field: Qistance from nearest well.....S�50._-f�- to ce-4 om foundation...._f .._..Distance to nearest lot line.... <br /> [[ Number of lines.........._f......-..._.........Le th of each line...-_-.6..C;--c_.........Width of trench....-..3/0._-._.-------...- <br /> • i <br /> Type of filter matanaL..R[7.L1S---.Depth of filter matenal..__1��__._..Total length........... .............._-........- <br /> Seepage Pit: Distance to nearest well......................Distance from foundation....................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..................................... 1 <br /> ❑ Size: Diameter......................................Depth..--..--------- ------------........_...........Liquj4 Capacity....-----..................gals. <br /> Privy: Distance from nearest well..._......__..-----....._-------------------Distance from nearestllding------------........................ <br /> ...... <br /> ❑ -Distanje tjo nep est:lgt IliP�-------�J- .,,a.=.`.:................-....._.............................._.................................................... <br /> Remodeling and/or repairing (describe):............................ - ....." ............................... ..................................w. ............... ------- <br /> ................ <br /> -...............--'•"'•-•'-"--....-.-................... '-'•"--"-----...-..._:... ""--"-"•....._.............Z . -•-......................... <br /> ...................................... ........... ......_.....-...---------------..........-......--.--- <br /> .-------------.........................................................................................................................................................1..................-------------------------------.... <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State lays, and rules and regal tons f A San Joaquin Local Health District. <br /> (Signed)... +`------; .................. --------'-._..:------- ------------------------------------------(Owner and/or Contractor) <br /> By:............. ...----..------------------------------------------------ .........--- --------------._--------------------...._(Title)------------------- ------------..._.. . <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY...._�t.:R.r..Q_:._........._... ..................... ....................... DATE------- -.z.-...`.AJ.................. <br /> REVIEWEDBY.................................... ./ J - - - - - ........... --------- <br /> - .---------..... DATE...._...----.......-----....-------- ------•-- <br /> _ BUILDING PERMIT ISSUED... 1r. at.T..-kt�2.._...S. PT(G._TH!�K....--. rr ..... DATE........ -- _...!�-....u..-- <br /> Alterations and/or recommendafions:..Oi.K._...W.I.TH:.....I=X7 <br /> 'T.,-.,b ] :PT)-C-...L_...._. <br /> --.......................... .. ... ......�.. �a..=.Ib .........._ A. ;f ).---. F���.1A.F: c x .......... . --............................-`. 1.9-0 <br /> ..........- t D f=r(fil.. .... I PVK. �.......... �.K.._.......twor7`�. ..... e/Y6------------------....------- <br /> ass �....:<°=sem......... tom' -- .�'.::.._(tv la ._ .!n( � 'O? 6141- '-0---.. ...._� ............. - -- <br /> ✓. <br /> r. FINAL INSPEC �Cl{f / ( .- C ------':_--------- -------_----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> see, 130 South American Strict 300 West Oak Street 124 Sycamore$frost 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E0,.9 REVISED 8.89 2M 5-62 ATLAS <br /> r <br />