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FOR OFFICE USE: <br /> Permit No. .G'.s-=--__-••--••-• <br /> -- --... ....._.. ..•-_-• ... j APPLICATION FOR SANITATION PERMIT <br /> _... ------ (Complefe-in Duplicate) Date Issued l..__ ..t?1�... <br /> ` This Permit Expires 1 Year From Date Issue <br /> . ... .. escribed.. <br /> k Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work �� <br /> f <br /> This application is made in compliance with Ordinance No. , 9` <br /> l ! <br /> JOB ADDRESS AND OC l s..... Zvp <br /> ...... - �4 <br /> Phone <br /> f Owners Name_..._..._ -- --•- -- ------------- <br /> Address -----•-------•----...----• • .......................................••-- <br /> ._........ .-4110u. a �_.,f <br /> 1 a�! ` ��1 fir...... Phone ��+�1v� . <br /> Contractors Name........_ .. �. Motel ❑ Ot er <br /> Installation will serve: Residence ❑ Apartment House'0-WCommercial-^-Trailer•-court ❑ <br /> Number of living units: _''".._ Number ofbedroomsNui�,be* of baths......_. Lot size . -- <br /> f Water Supply: Public system C3 Community system ❑ Private <br /> epth to WaterTeble ft <br /> I Character of sol) to a depth of 3 feet Sand Q Gravel ❑ Sandy Loam, lay Loam ❑ Clay ❑ Adobe❑ Hardpan❑ <br /> Previous Application Made: (17jyesjdote_--_.... ......... } No (�NewrConstruction: Yes❑ No FHA/VA: Yes ❑ No�}^" <br /> f t . ti <br /> I TYPE OF INSTALLATION ANDSPECIFICATIONS: � I <br /> (No septic tank or cesspool,pelrnitted if!public sewer is available within 200•feeti-I + <br /> I » e1. <br /> . Material................................................ <br /> Septic Tank:L Distance from nearest well_-----------_- from foundation___..._..__._._.. <br /> i t�Tt44 No: of compartfie ts...-...-------•----- ----Size------•• •.............:.....Liquid depth--.------....... ......_.Capacity. ' <br /> -.7 .v� <br /> Disposal Field' QistariCe fcom neares ell. (' ---Distance from foundation -w? ._.!.Distance to nearest I� line,/�� <br /> " , ` (�__-.Width of trent ivk <br /> Number fines..__:t+ -Length of each fine. a 1. ..�.................... <br /> `IG� —Depth of filter material. � Total length_. (� <br /> Type of?.filtJr,..lt1 tion p -- <br /> �� y / e/ sr�.... <br /> tep ge Pit: Distance'to nearest well.. :"Distance from foundation.-----.Dista, to nearest lot lin C <br /> Linin material.,/ f-Size: Diameter��•--- ---Deptha.�4 <br /> Q� Number of pits.-_r�±�--- 9 11 It <br /> ` Cesspool• Distance from nearest well ._-.__..`_._._ Qistance from foundation_.._._.._•---- -L�nuid Capacity gals. <br /> ❑ Size: Diameter- '------------•------V epA'r----------------------------•------- --•--- q p y.... <br /> Distance from nearest well ................�,�•-�-•---••--- <br /> Distance from nearest building................................• --•--.. <br /> Privy: /4. •--••••... ;- <br /> .................. <br /> Distance to nearest lot line.-.- •---------"•-... <br /> Y <br /> t Remodeling and/or repairing (describe):. ......... .11 . <br /> .................................................... <br /> -----------•------- ....................................... <br /> s •-•---. •--••-•. --•-•-•------------- - .-----------•----•--------•----------•--.................. -----------..-......_ <br /> :; <br /> :............................. ------------................................. _-. .............................................. .. <br /> I hereby-certify.that I have prepared this application and that.the work will be done in accordance-with-San Joaquin County <br /> [ordiriances, State laws�anddru!8 andregulations of he San Joaquin Lo I Health District.1 Qbr Contractor) <br /> i ......................... <br /> (Signed) I ; (Tule}._ y ............... <br /> By------------------------------- -- .......;.- -- <br /> buildings, etc., can be plat ed on reverse side). <br /> (Plot plan, showing sire of lot, location of syste' e ation to <br /> Wells,r _� <br /> ` + FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.��_.�.:/.:- ..__..GS�---• .� . _. '"-�•----�� DATE.:'.'".: ��� --••---•.-..---•---•----•._ . <br /> ---------­-- ---- DATE---------------------------------------------------- ._.. <br /> REVIEWED BY-----'----------------- --------- --•--- G9ia ._.... DlvTE -....................... <br /> l _._.._/hS .r-........ <br /> BUILDING PERMIT ISSUED.................------/5,-- --- � <br /> i s <br /> ................•----•-- <br /> Alterations and/or recommendations: •- - •-_..... <br /> ...................................................... <br /> i .......------I....................................._......... <br /> � M , Date...._.�z�.-//.__-.� .... ........... ...........:......... <br /> _ <br /> FINAL INSPECTION BY:..... -.•�=-�- s <br /> 1 SAN JOAQUIN LOCAL HEALTH.-DISTRICT <br /> 1001 i.Naselton Ave. 900 west Oak Street 124 Sycamore sireet M 206 well 9W Siroet <br /> Uackren,California I <br /> Lodi.California Manteca,California T,Pdcy,California <br /> E.M.9 2M 1.67 Vanguard Press <br />