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FOR OFFICE USE: <br /> ----------- ­.- o.------- ­---------- - N Permit N <br /> APPLICATION FOR SANITATION <br /> - --------­--- ------ <br /> (Complete in Duplicate) Date Issued 77� 76......... <br /> ----------- This Permit Expires 1 Year From Date,Issued <br /> to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> g1gs-1 <br /> This application is made in compliance with County Ordinance No. 549. <br /> I <br /> JOB ADDRESS AND LOCATIONIV�l/9 ?- ---- -- <br /> ----------- ... .. .... ;r <br /> .... Phone .. ..... ............. <br /> Owner's Name....OW ------------ ko­ .R...- ----- <br /> ............................................ <br /> -----------------------........ D..Jq'tP------- ...... <br /> Address.............------_ ...... ..)" �5 <br /> .1.% .................... Phone..... ,A�MjP <br /> Contractor's Name---- ................_5" .......... ............. <br /> .......... <br /> Installation will serve: Residence 0 Apartment House [I Commercial [] 'Trailer Court El Motel Other [3 1 <br /> Number of living units: 1-0.. Number of bedrooms - Number of baths .1.0 Lot size <br /> 9 t,,,&Water Supply: Public system El Community system EI Priva to Depth to Water Table*57-ft. <br /> Character of sail to a depth of 3 feet: Sand C] Gravel 0 Sandy LoamE❑ Clay Loam 0 Clay❑EAdobe) Hardpau <br /> Previous Application Made: (if yes,date------------------- No)9- New Construction: Yes No E] FHA/VA, Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic lank or cesspool permitted if 615 war is available within 200 feet.) <br /> Septic Tank: nearest well .- __�. aterial,---------......................... <br /> Distance from ns--Distance from foundation-10...... <br /> I'Ll — Liquid ------ C a p a c i <br /> No. of compartments.____10 ...__fsize-------------­------------ 1 . .. -est lot lin <br /> Disposal Field: Distance from nearest W_CIIj;Z4.5._Distance from foundation--- ...Distance to near 7- <br /> #4 <br /> Number of lines Length of each line--------- ....4a <br /> ........Width of french <br /> Type of filter Depth of filter material-------/.1?.!.!___Total length___________554P ----------- <br /> Seepage Pit: Distance to nearest well, :g(p-5 1/ 15_!...Dist,)nce to nearest lot line..-../�....... <br /> Distance from foun ation4ol- - V__.5Z <br /> Number of pits---�-�ql.-_ I..Sth A iza: Diameter-*—'Kl Depth.._..... I .__10 <br /> --l-ining materia 4 <br /> jo#..— -.1ining material..................................... <br /> Cesspool: Distance from nearest wVl----------....-Distance from foundation-------------- <br /> 171 Size: Diameter..........................__........Depth_----------_-------------- ------- Capacity ---------------.gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building--------------:----------------- <br /> F1Distance to nearest lot line..-._--_-------------------------- --------------•-------•-----------------••--.......-----••-•---•-•.._._..----......------••-•---- <br /> ....... ............................................................ <br /> Remodeling and/or repairing (describe):------_------... . �2m�......111"...... <br /> ---------------------........................................... ------- <br /> .............---•--•.........................I...........i..................................................... ...... ---------------___---------------------------- <br /> • <br /> .......-----------........................... ...............I............................................................................................ ...........--------i............ <br /> -­---------------------------------1-.1-1------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Slate laws and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---- _ ............� .­­......... ---------------- ...... -----------40wner and/or Contractor) <br /> ------------------------- <br /> ......................................Title--------- .... ......... <br /> By:__..............------------................. .........­----------­.................... 17 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE..... ... ... ---------------- <br /> APPLICATION ACCEPTED BY................ ---------"D <br /> ............ .. ....... <br /> REVIEWED BY..--- ---------_-- ............................................................ ..... -------- DATE_--- z <br /> ....... <br /> BUILDINGPERMIT ISSUED............... --------.............------._..........----------------------•-- DATE <br /> Alliterations and/or recommendations:.__.._. ...... ........ <br /> fti <br /> �76 ------------- .... . <br /> ...............e­e�........ .................. <br /> ------­----------- ....... <br /> ................7- . <br /> ........................................ <br /> ------­---------------- "- <br /> -Ze <br /> .................. <br /> -------- ---............. ...... .................... ..... .............................................. ------------------------------------1-1--------- ................... ............. <br /> Y ------------------------- ....... ............................ <br /> FINAL INSPECTION BYA ------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Sovlh American Street 300 West Oak Syre*f 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,Callfamla montoca,California Tracy,California <br /> 11rv16ro 2"59 014 5'11 AILAII <br />