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FOR OFFICE USE: 1 <br /> ...................------------------ -- ----------- <br /> .................. APPLICATION, APPLICATION ;FOR SANITATION PERMIT Permit No, ,2.�-7/_. <br /> -----•..................••- •..__-.-......._.._.. (Complete-in Duplicate) d� <br /> Date Issued <br /> ............................................. This Permit Expires 1 Year From Date Issued 2 t rY, .r bc{Q--•!O .. <br /> +pplication is hereby made to the San Joaquin Local Health District for a permit to construct end install the work herein giscrImed. <br /> •�j This ap.plication.,is,.made-in.•com.plisnce with County Ordinance No. 549. <br /> *_[..83.0..E.--L�Q-"rlt(r7° <br /> JOB ADDRESS A."LL CATIO .. <br /> ••---- ••. . ••• • •-�•o•- <br /> Owner's Name.... Phone. _ <br /> Address- _-------•-•--Ze---3-- .-�.._.S._ <br /> A ... .... -- • ------.----- ..----•- -• ---...-----••----•-•-..........•••---•------•••-•------••......... <br /> Contractor's Name.................. _... --_...._............_....-•----•-••--• Phone4l��P.Pl.... j <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court rQ Motel ❑ Other Q <br /> Number of living units: --I... Number of bedrooms :4... Number of baths 4__ Lot . <br /> Water Supply: Public system ❑ ':Community system ❑ Private$ Depth to-Water Table- ... ft <br /> Character of soil to a depth of 3 feet- Sand $1 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Q <br /> Previous Application Made: (If yes,date-......... ........ I No New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No�r <br /> -TYPE-OF INSTALLATION'"AND SPECIFICATIONSi_ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Wank: Distance from nearest well.................Distance from foundation_____.............Material .................................-............. <br /> []it)(t S 17 No. of compartments..........................Size._.........._:....._............Liquid depth...-..... .......�....... Capacity.......... <br /> fi <br /> Disposal Field: Distance from nearest wellAW ....Distance from foundation..:7.........Distance to nearest lot line._ <br /> I�. Number of hnes.__T _. Length of each line_...._S ._. ........... of trench...Z:�f.F�................... <br /> Type of filter material. C >�' .-:..Depth of filter material_._�.. ...........Total length.---_1� .._..____. ._._...... { J <br /> Seepage Pit: Distance to nearest well......................Distance from foundation_........_---------.Distance to nearest lot line_.-_.__....-.._. � <br /> ❑ Number of pits.....................Lining material...................... Size: Diameter------------_---..----Dept h...............................-- + W <br /> Cesspool: Distance from nearest well ................Distance from foundation...................Lining material...................................... <br /> ❑ Size: Diameter. .. .......••-•-•................Depth....................................................Liquid Capacity............................gals. j <br /> r <br /> Privy: Distance from nearest well.............. --------------_--------- Distance from nearest building.................................._....... <br /> ❑ Distance to nearest lot line... -- ----- - ---------------�--•-------.._....._.._....._..........--........---------- - <br /> /D . <br /> Remodeling and/or repairing (describe) K------•-•-• - .--•................•.....__...........: <br /> ----- .......................................-----..--_---..__.... -------•-••-__............................................................ .._....................--•--...----------....... <br /> 14 1 hereby certify 'that'l h prepared this application and the the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, ,and s and regula ' s of the San Jo uin Local Health District. <br /> (Signed)............................ ....... __.. . ....... - ...-• .................... -........................... .(Owner and/or Contractor)w <br /> By:--- ------------------------ --- .. --. - • - _ ........(Title} - •----- -------- <br /> ...------- <br /> �^ (Piot plana showingsize of to , location of syst in relation to wells, buildings, etc., can be place"n reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__.._ zR._Q-.---.--.-.-------•---------• ----... --------------------.._. DATE114_`Zk.'.s�i�r�.......-____............... <br /> -,REVIEWED BY...---------- ------------•-•-•' -.. <br /> --••---... .........................-•.................................................... DATE................ --•-•----................................. <br /> BUILDINGPERMIT ISSUED........ ------- ---_-_-----------•—...... ----•----............ ......... DATE........................_.................................... <br /> Alterations and/or recommendations:.......................................... ..............................................................._........_... ..........................._...... <br /> .........................................-----.............................................---....__----------------------------------------------------------------------------------...- --- ----- ---- <br /> ..................................................... .. ... ................. .................. <br /> ...................... <br /> ................................................ <br /> FINAL INSPEGTJ- N B . . • -----. Date_....,-•-.• �.'26..:5'���_...-----•----•---- ...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 'rA 1601 f.lfaseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> r <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Prem ^ <br />