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---­-----­----------- ---------- ------------ -- <br /> A rICATION FOR SANITATION PERI Permit No. fl <br /> -- - ------------ --_ ------------------ --------- (Complete-in Duplicate) S / - <br /> ------------- --------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. v� <br /> JOB ADDRESS AND C ION.. d� ...- ...dJ?�y !}aQQ - <br /> Owner's me. . <br /> t� - - --- ----- --- ---------------------- ---------- Phone�of_..tZ/2. Z-O.LL <br /> Addresslt,... -' <br /> Contractor's Name..... .... ----........ fK-c... �E' ! l_ ._d�7s J-------..... --'-- Phone--7W0_ 1 <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> I <br /> Numbet,of living units: ....... Number of bedrooms -------- Number of baths.---..-. Lot size ... ......... .... <br /> p-�Ay"�Rf=-�CT..f . .... <br /> Wafer Supply: Public system ❑ Community system ❑ Privgte)X Depth to Water Table �ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe0 Hardpan <br /> Previous Application Made: (if yes,dote---------------- ) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance from foundation..................._Material.--------_____------------- ----_.--.-. <br /> ❑ No. of compartments.---_-----_-.---_--_Size-------------------------------Liquid depth--------- ------ ----.-- Capacity----------------------- <br /> Disposal Field: Distance from nearest well----._..........Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of lines---...............................Length of each line_---------1------.-----------Width of trench...-..__-------------c.--------- I <br /> Type of filter material------------------ of filter material----------------------Total length.-----_..-.............................. <br /> Seepage Pit: Distance to nearest well_.-!6�5D.........Distance om oundation........._........Distance to nearest t�o ,ij�a°e��_----- <br /> Number of pits_._---..----_.--Lining material--material--j=,.... Size: Diameter.----�iEti_.......Del th-_OTA----------- ------ <br /> Cesspool: Distance from nearest well................Distance from foundation-----------....-- ..Lining material-------.----------------- .--------- `d <br /> ❑ Size: Diameter. .. -------------- ------------ Depth------------ - - -`------------Liquid Capacity...------------------------- <br /> Privy: Distance from nearest well.......--------------------------------.-----__Distance from nearest building-----------------------................. •� <br /> ❑ Distance to nearest lot line---- ---Qp...--�---/�"---------------------------.............._-..-_-..._--"---------------------------'---------- <br /> Remodeling and/or repairing (describe):.__.-__aQ�4fJ- ---.-.- _�'�` <br /> -----------------------------------------..... ---.......-... ---- --`-------------------`---.-_---_---------- .----... - -.-- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State [a^ and rules a id regulations of the San Joaquin Local <br /> Health District. <br /> (Signed)............ _v..-" !�! ---------( nor and/or Contractor) <br /> By:......-----------""'--------- ---------- <(..LlL.4.id.....-.....................(Title)------------------ ------------_--...._...__-...----.... <br /> (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY k R.-Q__- <br /> ------- ----- - - - --------__.---------------- ------ DATE----- -5--7-3-76 <br /> REVIEWEDBY-------------------- ' ------- -- ------------.'---------------------------------------------- '---.. DATE------------------------------------------------ <br /> BUILDING PERMIT ISSUED.......... ......----------------------------------- -----------------___.......... <br /> ---------- DATE.-- ----------------.. ----'....... -........ - <br /> Alterations and/or recommendations:....................... ----------- - .........................--------.................- ......-.........-...... ........ <br /> ----------------------------------------------------------------------------------------- ............................. .......................... ----.........-----'--I..... '......................... <br /> ........------------- ----------- ........................................... --------------------------------'---- -----11.................................--'-------------------------------------- - <br /> -- - - --- .................- . ---------. ..... ............--------------- f---------------. .--- _ <br /> --. .... <br /> FINAL INSPECTIO _- - - -------------- Date......__ -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.92M 1.62 Vanguard Press <br />