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FOR OFFICE USE: �4 <br /> -----OFF-I-CE-U ISE ------------- PERMIT Permit No. ... ............ <br /> -- --- -- -- ---- ------- <br /> :- ---- -- --- -------- <br />---------------------=----------------------------------- <br /> ------------------ APPLICAT10N FOR SANITATION '3 7�6y <br /> ------------ -- Duplicate) Date Issued ------- ........ <br /> (Complete in I <br />------------- -------------- -------------------- This Permit Ex ices I Year From Date Issued <br /> ------------- -------------- ------ <br />------------- stall the work h in described <br /> Applica.tion is hereby made to the San' Joaquin Local Health District for a permit to construct and 94-- <br /> Ordinance No. 549. Vee�_ <br /> compliance with County <br /> This application is made in cc <br /> OG1 3;u IJ'. <br /> 4 � � 3 ------------------ <br /> JOB ADDRESS AND.LOCATION----- ...... -------:7­____7- <br /> i", '46 - �V� -------------- -------------------------------------------- Phc;k1e__C-7ty_e_'s---------------- <br /> Owner's Name_____ ------?__ -—--------------- ----------- <br /> ------------------------------------------------ <br /> ---------------------------------------------------------------------...... ------------- <br /> Address---------------------------- -C .4 1--- Phone------------------------------------ <br /> Contractor's Name-----A!Oa4,��-,ek------ Motel, [] Other El <br /> Installation will serve: Residence �4 Apartment House F1 Commercial 0 Trailer Court),.[] ------------------------------ <br /> Number of living units,: ___.I_ Number of bedrooms -a---- Number of baths Lot'size ----- <br /> -- <br /> Water Supply: Public system F1 Community system 0 Private IX Depth to Water Table _490- ft. <br /> lay Loam 2q Clay ❑0 Adobe[] Hardpan 0 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam El C I No <br /> Previous Application Made: (if yes,,date------ ------------- <br /> No New Construction: yes n No A FHA/VA: Yes [] <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 /> --------- -----------------Capacity----------------------- <br /> W. of compartments--------------------------Size-------------------------------Liquid dep}h <br /> El a&_1t_4 - <br /> rest well-----------------Distance from foundation---------- -----------Distance to nearest lot line---____-___..___- <br /> D'15P <br /> oral Field: Distance from neaeach line-----------------------------Width of trench.-------------.------------ ------- <br /> E] 'Number of lines-----------------------------------Length of lilt.er material----------------{-__..Total length------------------------------------------ <br /> -Vr Type.of filter material--------------------- ---Depth of <br /> Distance to nearest lot line....... <br /> Distance to nearest well—M49..........Distance from foundation-__ "-.----Depth----------I's—!------------- 5> <br /> Seepage Pit: -, f�-X— _1� <br /> ,�F ---.Size: Diameter <br /> -----------Lining r�aterial__'Zl -.57 <br /> INK Number of pits.--------I <br /> .4 foundation____________________Lining material-------------------------:_;-------1_ 2 <br /> Distance from nearest weil------------- ---Distance from foundation-------- -------- <br /> Cesspo-ol- .1 ..- ---------Liquid Capacity_--------------------------ga 5- <br /> --------------------Depth....................... <br /> Size: Diameter.-'-------------- <br /> yr <br /> Distance from nearest building.._.--.-_____-_-___-___.-_____---.__--- <br /> Privy: Distance from nearest well__:---------------------------------- --------------------------------------- <br /> - L2-11�1line__---------------------------- <br /> ----------------------- ­-------------------------- <br /> El Distance to nearest ].Of --------- ------------------------------ <br /> Remodeling and/or repairing (desc i ribe)------------I 4:_2�w----------- ------------- -------- ------------------------ ---- --------------- <br /> - - --------- <br /> ----------------------------------------------------- <br /> ----------------------------- --------------------------------- ------------------------------------------------------------------- <br /> 1 ----------------------------------- <br /> --------------------------------- <br /> ------------------------------------------------------------- ------------- ------------- <br /> ------------------- -------I-------------------------- <br /> --------------------------------------------------- <br /> --------- -------------------------------r------------ prepared this application and that the work will be done'in accordance with San Joaquin County <br /> I hereby certify that I have p.r Health District. <br /> ordinances, State laws", and rules and regulations of the San Joaquin Local <br /> -------------------(Owner and/or Contractor) <br /> --------------------------------------------- <br /> - <br /> (Signed)------------------------ ------- <br /> -----------(Title)------------------------------------------- - ------ - - <br /> --------------I--------------- <br /> -- - -----­-------------- <br /> By:------------------- ------- <br /> ) <br /> (Plot plan, showing sjzel�oftlot. location.of-sys*dA in relation to wells, buildings, etc., can be placed on reverseside. <br /> -FOR DEPARTMENT USE ONLY <br /> bATE------------------- ---------------------------------------- <br /> APPLICATION ACCEPTED BY_------------------- —------—-------- ------L---------------------------------- <br /> �: I -- ----------------------------- DATE-------------------------------------------------------- <br /> r:BY-------------�--f---------------- -------------------------------- <br /> ---------- --- <br /> --------------- DATE------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------ ------------------------------------—-------------------- - <br /> ---------------------------------------------------------------------------------I---------- -------------- <br /> Alterations and/or recommendations--- ------------------------------ ----------- --- ----------------------- <br /> I- -------------------- --------------------------- <br /> ----------- ------ <br /> ---------------------------------------- ------- -------- ----------------------------------------------- <br /> ------ -- ---4-1---W--------- <br /> ------------ -------------------------- <br /> -------------------------- --- --- ------ --------------I--------- <br /> - ----------- --------------- <br /> L-- -----�-"� ­_­_ 4�----- e-- ----_-- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----- ------ <br /> ------- <br /> ---------------------------- <br /> ------------------------- - <br /> Date- - 4/ <br /> -- <br /> FINAL INSPECTION BY:--------- --- ----- -- ---- - <br /> 7 ------------------ <br /> x <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 205 West 9th Street <br /> 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street Tracy,California <br /> Stockton,California Loch,California Manteca,California <br /> ES r <br /> 9 RrVj86j3 8-59 3M 3 .3 F,F <br />