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.. <br /> FO,R OFFICE USE: <br /> APPLICATION FOR SANITATION P <br /> Ty <br /> - � ERMIT Permit No. <br /> 11 4ly- <br /> - -- (Complete in Duplicate) <br /> 1 This Permit Expires 1 Year From Date Issued - " Date Issued i` - `----� <br /> h- ..-- ------------------------- <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is-made in compliance with County Ordinance No. 549. I <br /> ,7 S�cE�-r�a <br /> JOB ADDRESS A D OCATION---3---Z-------� ------ 1_ _ <br /> Owner's Name Phone--- 3~'3J 3� I <br /> L�e <br /> Address------------_---9-� -- ---- •-----• - --------------- <br /> Contractor's Name------ --- --- - -- -------- ---- ------ .--- ------- -------------------------------------------- - Phone--_4_ _ . A, --- <br /> Installation will serve: Residence .K Apartment House ❑ Commercial ❑ Tra0er Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ ----- Number of bedrooms ._ Number of baths-1----- Lot size ............. <br /> Water Supply: Public system K Community system ❑ Private ❑h Deptkfto Water Table 767_ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ ' Clay Loam [❑ Clay ❑ AdobeK Hardpan ❑ 1 <br /> Previous Application Made: (If yes,date_.................. ) NoNew Construction: Yes ❑ Not4--F44A/VA: Yes ❑ NoX <br /> 3 1 <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 /> i4lS4fli[76 No. of compartments---- _-------------- ----"Size---------- -- -------•---Liquid depth--------- ----- - --------Capacity_---- - --- -- -------- <br /> - pp <br /> Disposal Field: Distance from nearest welIA)0j4).h.Distance from foundation__/_S7'..._....Distance to nearest lot line.- =__ :.. '- t <br /> (� Number of lines. 4.[f_ ----------Length of each line__.-1------------I----------"Width of trench----------------------------------- <br /> Type of filter material---------- ----------Depth of filter;material--------._'-----_-...Total length-.__-.--------_-_-_-.-----_-_-_----_---- <br /> Seepage Pit: Distance to nearest welL.�J©A?K---Distance am f ndation---��__.._l_--.�Distance to nearest lot line.___.--_.. , <br /> Number of pits--Cl-)-----------Lining material' -- .f_ .3_3! -.Depth-��------------------ <br /> _. Size: Diameter__. <br /> Cesspool: Distance from nearest well ----------------Distance from foundation................. ."Lining material-----------.---_-.-..._-----__----_-_. <br /> ❑ Size: Diameter. ........Depth--------------- --------- --- --- -------- -- ----Liquid Capacity----------------------------gals. G <br /> Privy: Distance from nearest`well_-_._..-____'----------- ----------- _ Distance from nearest building <br /> ❑ 4 e ` e <br /> Distance to nearest lot line -------------------------------------------- <br /> Remodeling and/or repairing [descrilae]:----._. ._.___.. _.... ---------- -- --- -- <br /> - ------ ------------- <br /> . <br /> E <br /> t <br /> ----------.---------------------------------------------------------------_----------------------------__..___.._____.-________._----------.--_--------__-_-__-_--------------.-___.__-.-__-_-..----....._-.._.______.____._._ <br /> I hereby certify that a prepared this application and tha+'the work will be done in accordance with San Joaquin County <br /> ordinances, State lage7icLfion <br /> les and regWations the San Joaquin L I Health District. <br /> - - -- ------ _- ----- -------- ----•------- Owner and/or Contractor <br /> (Signed)--------------------- � � { / 1 <br /> B �-�- ------ - --- -- ---(Title)----- <br /> By: ---- .4------ - -- - ..e) <br /> (Plot plan, showing s of sys+em in relation a wells, buildings, etc., can be plat on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_.. DATE- y`6-7------------------------------ ti <br /> -�-- - -------'I ----- ------------------ <br /> REVIEWED BY------------- ----------------- - - - ------------------------------ - DATE-- ----- ---•------------ --------------------------------- � <br /> BUILDING PERMIT ISSUED-------- -------- -------------- DATE <br /> ----- --------------------------------- <br /> Alterations and/or recommendations:._._ ) <br /> . w . <br /> - ........ ------ <br /> - <br /> v 19 <br /> _- �Z.2.� _._,f --------------= -----=------------------- -- ----- -------- -------------- ----------_-------- <br /> -------- ---------------- ------- ­-------------- --•-------------- --------------- -------------- -------------- ------------------ ----------------------------- --------------- ------------------------- <br /> -' -- `- Date-------- � '��� <br /> FINAL INSPECTION <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />