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FOR OFFICE USE: <br /> yf <br /> --------- -------------------------------- <br /> APPLICATION "FOR SANITATION PERMIT Permit No- -- ------------------- <br /> --------- ------- --- ------------- -------- <br /> ------- --- ------------------ ... (Coirnplefe-in Duplicate) <br /> Date Issued _--- -- <br />----------------------- ---------------- This Permit Expires I Year From Date Issued -- <br /> Application is hereby made to the San Joaquin Local Health 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 LOCATION-----epla ------e--"---- ------- ------------------------------- <br /> Owner's Name----/V <br /> --------_--------_-- ...... !­� �-------I----------------------------------- .............. - - ------------------------ Phone <br /> Address ------------------------------------ <br /> ---------------------------------- ---------------------------------------------------------------- <br /> ----------------------------- <br /> Contractor's Name....lofao�_ __-TI-e4AP1�1U ----------------- ----- ------- ---- - --------------------------------------. Phone- __-------------------_---------- <br /> Installation will serve: Residence ['Apartment House E] Commercial E] Trailer Court E] . Motel E] Other E] <br /> Number of living units: --/-- Number of bedrooms _3"F_ Number of baths.-,X.- Lot size __- 1.r ' ---_-`-- ----------------------- <br /> Water Supply: Public system E] Community system El Private g4- 5epfh to Water Table ft <br /> Character of soil to a depth of 3 fee+- Sand E] Gravel E] Sandy Loom E] Clay Loam Clay E] Adobe E] Hardpan C] <br /> Previous Application Made: (if yes,date_------------------ I No PR-- New Construction: Yes Up- Mo E] FHA/VA: Yes Fg— No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No Septic tank or cesspool permitted if public sewer is availa'ble within 200 feet.) <br /> Septic Tank: Distance from nearest well-// -Disfance from founc1afion__1.--:'1L1-----------M a t Q r i a I ,47,4e,�w x4? <br /> XXj6_Liquid dep.fk- "__" ------- Capacity/__Z-4�.... <br /> No. of compartments---,Z......------- - Size $V1�w <br /> X p. <br /> Disposal Field: Distance from nearest weJ..A0j0._._Distance from foundation_..... ..........Di'stance to nearest lot line-4----------- <br /> L_engfh';f each lin-e__ Width of tre;�h.2--**----------------------- <br /> Number of lines ------ -------- --------- <br /> Type of filter maferiZ ____;9,9*0tbeptk of filter material---loe --------Total length----!Zd---40_____________________ <br /> 4' <br /> _. —T0 " <br /> Seepage Pit: Distance to nearest well-,eZ ... Distance from foundation--- <br /> ------Distance to nearestjot line_. ._ _ <br /> Number of pits.__ A-__-_-___Lining maferial,/A?19Size: Diameter---3-.7""------ Depfh,2.6y o-_- <br /> ---------- ------ <br /> Cesspool: Distance from nearest well ----------------Distance from fourijailon - ------------- -.Lining material------- ----------______-__--_____ <br /> ❑ - Size: Diameter- -- -------------- ---- V <br /> .. .....7D --- ---_-----------------Liquid Capacity ---------------------gals. <br /> Privy: Distance from nearest well., -A------ - ----------------------------------Di`stance from nearest building-___-_--____I----------------------------- <br /> ❑ Distance to nearest lot line --$ -- -'A----------- --------------------- - ------------ ------------ <br /> -------- ------------------------------- - <br /> 01' <br /> r Of-- <br /> ;R.ernodeling-i-nd/or repairing (describe):------ --------------------------- <br /> -----------•-------------------•-----•-------------------------------------- ------------------------------------- <br /> ------------------------------ ----------- --------------------------------------- <br /> t+i <br /> ---------------------------------------------------------------------------------- ----------------------1---—---------------r------ ------------------n_------ ----------------------- ------------------------- <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 /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> -(Signed) ---—------ ------(Qn3lx=zmdj4o�Contractor) <br /> ------------------------- --- --- ----------------------------- ------ -- <br /> ------ --- ............-------- -- ............. ------- <br /> By:-------------------------------- ------ ------------- . <br /> '(Plo+ plan, showing size of lot, location isys,e in buildings, etc., can be placed on reverse side). <br /> M I <br /> AV! <br /> FOR DEPARTMENT USE ONLY <br /> .A - --- --- ------------------------------ -------------- DATE._,:;Z----.1 ---�'?--------------------------- <br /> APPLICATION ACCEPTED BY----.-- __ __ . _�L <br /> . — f <br /> -'REVIEWED BY------------------------- ------ ------ - --------- --- - --------- ------------ DATE------------------------ <br /> BUILDINGISSUED-------- ------------------------ <br /> ---........ <br /> PERMITISSUED-------- -- -- -- - -----J!------ ---------------------------------------------_--------------------- DATE------------------------------- -------------- -------------- <br /> Alterations and/or recommendations:--- I__!-------------------------------------------------------------- ---- --------- --------------------------------- ------------------------------------- <br /> -------------------------- --- ------------------------ --------- ------------------------------------- --------------------------- ---------------------- ------------------- <br /> -- ---------- --- --------- ---------------------------------------- ----------------------------------------------------------------------------------------------------- ---------­­----------------------------- <br /> ----------------------- ........ --------------- ------ ---------------------------------------------------------------------------------- -- --------- ---- ------------ <br /> ................ ----------------------------------------------P <br /> -------------- ............ ------------------------------ --- - - - --------- -1­---------- -- ------ - - -------- -- ---------- <br /> �1` 1 2 <br /> FINAL INSPECTION BY:.e-', - ------------------------ Date.,".. ............................................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Avis. 300 West 0"k Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi. California Monte,.,California Tracy,California <br /> E.H.92M 1-67 Vanguard Press <br />