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!DR OFFICE USE: • ' <br /> i!707:77777 APPLICATION FOR SANITATION*RMIT Permit No. /T_73L1- <br /> . .. . . ........ <br /> (Complefe in Duplicate) Date Issued <br /> . ...... ....... . 3 -G-`� <br /> ____.._..... ... This Permit Expires S Year From Date Issued <br /> Application is hereby mode to the Sen Joaquin Local Health District for a permit to construct and install the work heroin descrbed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> x/19° E- >- . . t <� _ <br /> Hien r� Z ..X.a..l..t.._.......rr......:7t�.:.Rtasa��l:.�..R..i?_ <br /> o' JOB ADDRESS AN OCATI N.�.:....... �`' .1- � _ �• ••• ♦•----- -----• <br /> Owner's Ne e..._..... Aq'/ LC^. ......_..(.,....t.'x.f:;. `�.l�tLfL..........._..---.... ........._.......... Phone <br /> ` > <br /> Address—. _ T_a=_:- _'_.7.�,-,X. J .�' �1..1..........ALMLi....:...__.._..._.._.._._.._.----...-- <br /> .. 1 _l ....................................._......... one.-__"' <br /> .. <br /> Contractor's Nama......�/.4Sl�.t�..^...... ................................................... <br /> Installation will serve: Residence E Apartment House ❑ Commercial ❑ Trailer Court ❑n Motel EI Other 13 Number of living units: _r.... Number of bedrooms��-.. Number of baths ..�.... Loi size ..{.7.CK1= _(T ^-----'--'- <br /> + Water Supply: Public system ❑ Community system ❑ Private LT Depth to Water Table- ft. <br /> 11 Character of sail fo a depth of:3 feet: Sand 0' Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe❑ Hardpan❑ <br /> Previous AppliceenfiMade: lifeyes,date....................i No V" New Construction: Yes Q' No ❑ FHA/VA:Yes❑ No❑ - <br /> { TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> j (No mp4ic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i Septi Tank: Distance from nearest we S� .Distance fro foundation....I............M j� I-`�---- <br /> LJ ............... l �} - 9 /j <br /> No. of compartments....... ......Sixe...J_x --Y.6 :Liquid depth.....2-.......Capacify_A-� ---�; <br /> Disposal Field: Distance from nearest well...s_ n....Distance from fougdetio�..-.�.f._.__Widt is to nearest lot li <br /> Number of lines........../.....................Length of each line.._...._.�.�1._.�.�/--Width of .�..— R+ <br /> " - Type of filter materiel._RV4.,J.-+.......Depth of filter material.....�JC-"•.._....Total length.:........._..�11_-•-•- <br /> -t-- GCls.ci f- E_ K6'7 i' , <br /> Seepage Pit;-`"" -Distance to nears we!I..................._.Uistenca from faNdetion.......___.__Disfance to nearest lot <br /> s ❑• I Number of pih._.._._:.-._-...Lining ma nal.^...........!.......-Size: Diemeten...._...............Depth..._.3�-------- <br /> f �° ` <br /> s <br /> Cesspool: :_ . ...Distance from neeresi.well__._.:._:_TTiHMO from foundation................il.inin material........._... <br /> _.__...__..-j 1 <br /> 9 <br /> C3c -.-1 Size: DiamdterL.......................e........Depth......._..:.........._...........................Liquid Cepecit�y � _._.._.._gals. <br /> .._ <br /> .....:.....:..........Distance from nearest building .�{�...�.....—� <br /> Privy: Distance from nearest well........IA.........._.. •g`"_y1 ;1W <br /> ti ❑ <br /> Distance to nearest-lot line......._'..:::...::...::........... ^`_<fKl(<+.w._--..._...._.._......_..----_-_- <br /> 0 <br /> AK- <br /> Remodelingend/or repeirin describe :.... ��L.):.)r 14....... h. _T.._.:._�..sSED....FC�B...._�p:LT<2M-.--sem.?--- 3 <br /> _..."R'k---P�IBI_'_l37_,'�3t`.... FIf� _ .. -- ._.. <br /> _.• 3.__s.!tel'+ ••----------_—_--- _ --._ ._._ ...._........... <br /> _........._-...._..__.._.............._.............._....._._..•----........... <br /> I hereby certify that I have prepared this application and that the work will be done in aecordance with San Joaquin County <br /> =: ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed} it J./.L4--=1.'r-""l...t.f..tt:c^✓ii .-.:: _ ............... (Owner and/or Contract") <br /> i .............. <br /> z (Plot plan. showing size of lot, location of system in relation to(v elk, buildings, eta., can be placed on reverse side(. <br /> i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..........'r7 <br /> - .K..0.. ............................................................... DATE....Z=-' -=L-.'.Fe./.....:...._._..._..... <br /> • . ... <br /> DAT ....................__...�....... <br /> REVIEWEDBY............................................................................................................................. <br /> BUILDINGPERMIT ISSUED..._........................................................_........ . .... ........ DA-TE......_....._-�------...........---..__...�--•- <br /> 3 ABerstions and/or recommsndNwns:.. ... ................ ...__._.......... <br /> L.E.I/.'iw.R•.. WlT1a................_.__-........ ........._....-..'_-.. <br /> ............................. <br /> ...-. =6 ...SYSTEM.....[5.---- ....E <br /> t1ARs5M. f3......._S.f9 ..5......_ AN.D..... .........F! <br /> ..A. e T � -...._.__.._....._._._ � .._. <br /> ..j,L........... i.. ... <br /> t <br /> } FINAL INSP" . .Qi.�.. ..... ..._. Date............./.... ��..7...c. r...__......._....._-_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4 1601 E.I:aulbn Ar.. 300 W.,,O.k 111.1 171 srremwa S~ 703 Wei*M Eeerr <br /> SSI.AIsn,C.Illsrni. L.4i,C.Ili...1. alanN.a,Calnamia Tra.T,CaaMNe <br /> r <br />