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FOR OFFICE USE: I <br /> ............ ................... <br /> ......................... .......!� APPLICATION FOR S4ANITrATION PERMIT Permit No. <br /> ..................... ........i (Complete-in Dupricafe) <br /> This Permit Expires I Year From Date Issued <br /> 1W Date Issued 142_772 `1 <br /> Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOC ie <br /> TION.... _7.W-/*~-&-- m... ...0.............. <br /> Owner's Name......-RA-111I---------0. I ..... .... . ..... Phone..-------'---' <br /> o......w............... <br /> A Z <br /> Address................ <br /> Contractor's <br /> ....... ................. .................................. ...... Phone................................ <br /> Installaflon will same: Residence h] Apartment House [] Commercial C3 Trailer Court [] Motel [3 Other ❑ <br /> It <br /> Number of living units: .1_--- Number of bedrooms .......,, Number of baths,........ Lot size ........ ........O.W-W.........WW.............WW....... <br /> Water Supply: Public system ;[I Community system tj Private ] Depth to Water Table ...... . ft <br /> Character of soil to a depth of 3 feet- Sand [] Gravel [] Sandy Loam L] Clay Loam Clay Ej Adobe 0 Hardpan& <br /> Previous Application Made: (if,yes,date........_......... I No 0 New Construction: Yes El No 0 FHA/VA: Yes D No E] <br /> .TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Z �­ - I . <br /> Septic Tank: Distance fro4 m nearest well.................Distance from foundation..... Material....... ........................................ <br /> ❑ No. of cor4partments-.,--,... ......._._.Size...._.......:.............._.Liquid depth......... ....... ..w.....Capacity----------- <br /> Ii <br /> Disposal Field: Distance from nearest well.................Distance from foundation...................Distance to nearest lot <br /> ❑ Number of,lines--------------- ---------__......Length of each line..............................Width of trench.,. ................_..__.._...... <br /> Type of filter material........................Depth of filter material......................Total length_............._.._....................... <br /> Seepage Pit: Distance t I <br /> o� nearest well......................Distance from foundaf -----Distance to nearest lot line_.............._.. <br /> ❑ Number oflpifs---w............._Uning material................... Size; Diameter.......................Depth..........._.....-.............. <br /> Cesspool: Distance 41m nearest well ................Distance from foundation..................Lining material_...__................................ <br /> El Size: Diameter- ..........................Depth--------- .....................................Liquid Capacity..........................gals. <br /> Privy; Distance from nearest well........___..._...___._....................Distance from nearest building........____._.........._..........._. <br /> M Distance,to nearest lot line.......... ........___------- ------------ ..................._:...........................­ ........... ------------- <br /> Remodeling and/or repairing describe)%...Of. <br /> 0---------------­ ­-- — --------............W-------W-----------------W-W---------- ------------------W-------------------------W---------- <br /> ...................................................--------------W--,--. ......W--­­­ -­-------------- -------*-----------* -,*,*-----------------------*---------­-----------­-­-­, <br /> --------------*W------------------*.....­­"'....W '.............--- <br /> .....W--*.....*'"*------------------*-----------W---------W....... --------------W ------ ----* <br /> .. <br /> .......................... ....................WIL.......... _­­.........WW............W........-W----------------------------W......W..................................W- --------W._...._.........._. <br /> I herebycertify that I hav e prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. ate laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)..... ------- .......... .......................................W...... ............(Owner and/or Contractor) <br /> By:......./mAe"�A—a ...----------------------W------------------------- - ____------4nfle)... ...........W---- -- -- ----- -- <br /> (PlU"1dn;-9h6*in9 in�riGGoFto—i;-ells-, Quild�lnjs-iifc_., can be placed an reverse eisI14 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ................W............... DATE,_A-A.-4.7--------------------------- <br /> REVIEWEDBY..._..-- ---......... .........WW.........I——------------w....................w_w............. ----- DATE._......._.. <br /> -----------*.......*...................... <br /> -BUILDING PERMIT ISSUED.... ........ - ­­­............................••-'--'----'......................... DATE... W,................­-----W.......... <br /> Alterations and/or recommendations:....----'....................WW...W........W..._......_.............___.......W.W........................... ...................W------------- <br /> ..........W.........................4......7:.......................................................... ---... ....... ................................W...........W.W...... <br /> .................................................--------................................ .... .. ...........W...................... ............. ............. <br /> I <br /> ...............................................................­..............................................W........ . .................................. ........ .............­. ­...... <br /> I <br /> ....................................... .......... ..................................... . ....... ........_-------------- ..........W.................... <br /> 0000, <br /> FINAL INSPECTION BY:.. ......... • D.f. ------- -- .......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ho.*11.n Ave. i 300 WW O.k 51n..f 124 Sycomon,Sine 20.5 W.0 91h Sk"P <br /> Slockto.,C.1ife,ri. ii Lodi. Colifornio M.M.,o,California Tracy,California <br /> E.H.9 2M 1-6) V.,,v.rol Pr., <br />