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FOR OFFICE USE; <br />—------------------=--——------——---——---—--——------------ / <br /> ____________________--.___----.---..---------. APPLICATION FOR SANITATrON PERMIT Permit No.1 __52Z <br /> --------------------------------------------------- (Complete in Duplicate) <br /> Data Issued <br /> ----------------------------------------------------- :This Permit Expires ] 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 co pI' with County Ordinance No, 549, <br /> JOB ADDRESS AND LOCATION---aft-------- ------- AR�',.XOR---•00 <br /> } ,;-- � <br /> A2 2---.-- /cS <br /> Owner's Name---------------- - R --- --- ------ 1 -,�S------ -- --- <br /> --- Phone------------------------------------ <br /> Address............__--------- <br /> -------------------------------•--Address----------------------- -- ------too 6--t----IAACY-------------------------------------------------- ------------'-------------------------- -------......... f. <br /> Contractor's Name-------------------------'--------------- •-•--------------------------------------------------------------------------------- •-------- Phone----------------------------------- <br /> Installation <br /> .--------------•--------.-.- ----Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 2-l"MC15' <br /> Number of living units: ------+- Number of bedrooms -------- Number o baths 3--- Lot size .---lOd.-- )-f-_.306--------------__------- <br /> Water Supply: Public system [-] Community system ElPrivate Depth to Water Table /P.- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej"P`ardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No i?**" New Construction: Yes_❑ No [-] FHA/VA: Yes E] No-B--- <br /> TYPE OF INSTALLATION AND-SPECIFI'CATI`ONS: "" "' f�r1P. � rxe =/RA 11 e4a.S —r�- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I <br /> Septic Tank: Distance from nearest well ---------Distancefrom four, Pion---JP---------- -------. <br /> [}� No. of compartments--------- ---------------Size---- X_- - '.?-------Liquid depth------.... _ --------- <br /> 77 <br /> Disposal Field: Distance from nearest well_. P._.Distance from foundation- - -U-! Distance to nearest lot l a____6- . <br /> Number of lines--------- g -_-_--. <br /> ----..-Length of each line-_______ __-_-- Width of trench____... .- -- <br /> Type of filter material-""-f'-._--f�L--___-Depth of filter material- f- ------_,------- ---- length------------------------------------------ <br /> Seepage Pit: Distance to nearest well-__------------------Distance from foundation--------.----------Distance to nearest lot line---------------.. <br /> ❑ Number of pits----------------------Lining material--------.------------- Size: Diameter-----------------------Depth__--------------------.-- ---- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___-----------------Lining material------------------------------------ <br /> Size: Diameter------------- --- -- --------- ------Depth ----Li uidclt .p y --_-------gals. <br /> Privy: Distance from nearest well----------- --------------------- Distance from nearest building ----- ------------------------------ <br /> El <br /> --------- ------ --------_❑ Distance to nearest lot line------------------------------------------------- ------------------------------------------- -------------------------------------- ------ <br /> Remodelingand/or repairing (describe)--------- - ------ - ------------------------ -------------------------------------------------- -------------------------------------------------------- <br /> ---- ------- ----------•------•---------------------------------- <br /> - wry <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),-f------------ - - - "-�~------------------- -- Owner and/or Contractor <br /> By:------------------------------------------------------------------------------------------------- --------------------------(Title)------------- ----------=--------------- - ------------ <br /> (Plot plan, showing size of lot, location of system in relation to <br /> s, buildings, etc., can be placed on reverse side). <br /> FOR DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED 8 ------ --- ----- -- ------------------------------ DATE--------- - ....... <br /> REVIEWEDBY--------------------- ......... ---------------- - --------------------------------------------------------------------- DATE------- <br /> BUILDING PERMIT ISSUED ---- ------- ----------------------------------------------------------------- :---- ------------- DATE-- ---------------------------------- <br /> Alterations and/or recommendations:_-_-- -------- n. <br /> ------------------------------ - ----------------------------------------- --------------------------------------------/--------- ----------------- <br /> --- is <br /> - ------------------- ----------- —------------------------------- -—---- ----— --- --- —------ —-•------ ---------- ----------------------------------------------------------------------------------------- <br /> FINAL INSPECTION ......... ' 2.j <br /> Date------------- 7---�-`-�°z - -- - - ---------------- ----------- <br /> QUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California ray Manteca,California a: # Tracy,California <br />