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FOR OFFICE USE: <br /> 'A <br /> --------------I------------------------------- --------- <br /> ------------­­_-------------------------------------- APPLICATIOW �OV SANITATION PERMIT Permit No. <br /> ------- -- -- ------ ----------- -------------- (Complete in Duplicate) 7 <br /> Date <br /> Issued <br /> Da --- ----- <br />- -------•-----------------_-..-.___..--._.-_----____.._.. -This Permit Expires I Year From Date Issued <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. <br /> 4 <br /> JOB ADDRESS AND LOCATION-----/-,/./ J-Va M <br /> - - - 1 <br /> : ----- -9---------y-------------------------------------------------V-------r---E-------C <br /> Owner's Name---------- ----Wj_ _1_A---- tEF ------------ - - ---------- - ------ Phone------------------------1--1-q------------ <br /> ----------- <br /> -------------- <br /> - <br /> Address - 17i-I----------NO-----=_MItA -------5T---------- <br /> Contractor's Name-------�_P_WIVEK----------------------------------------------- ------------------------------------------------------ ...... Phone-----_-----------•---------------- <br /> 1 Installation <br /> hone-----_- -------------------------- <br /> Installation will serve: Residence 0'*-Apartment House L] Commercial [] Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units: --j... Number o Z f bedrooms -2-- Number of baths Lot size ---- 15-- --------------------- <br /> Water Supply: Public system -E] Community system El Private� F_111D'epth-.to W 45�( ft. <br /> Water-,Table _ <br /> Chara'aei--of soil,to a depth df 31f4f -;Sancl--[�ravel [:] --Sandy Loam E] Clay Loam Ej Clay [] Adobe Cj Hardpan [1 <br /> Previous Application Made. (If yes,dot 4 <br /> No New Construcfion: Yes [-] _No E2- FHA/VA: Yes 0' No <br /> oe <br /> TYPE,-OF I NSTA LLAT-I 0 N-ANDSPECI F]CATIONS: <br /> (No septic tank or cesspool permitted if Public sewer is available within, 200 feet.)_, <br /> Septic Tank: Distance from nearest well'---s-0Distance from foundation _0_._.__ <br /> 0 _.Materi <br /> M,f I r01Vf R F`!- <br /> a, o a irn --------jSize---y .......(fa pacify---/;? <br /> Er f cdImp''r ---- ---------Liquid dep�l <br /> Disposal.Field: Distance from nearest- ell from foundation.----/12--_-_�Distanc1i to nearest lot line_-________.____-_ <br /> - <br /> w <br /> -Number of lines-- ----------/14----------- -------tLength of each line------ --Oidth"of <br /> material---9,92CL-K....`Depth of filter material------ ----------Total length______________ ___ /0-0------------ <br /> Al Type of filter <br /> Seepage Pit: Distance to nearest well________________ <br /> _____-Distance from foundation-------------------rDist8nce to nearest lot line_____..___.❑ ------ <br /> Number of pits-1--------------------Lining material-----------------------Size: Diameter------------------ ---Depth--.------------------------------ <br /> Cesspool: _,"'Distia"rice from nearest well well-----------------Distance..--Distance from foundation------------------Aining material_;----------------------------------- <br /> n <br /> - --------------I------------ <br /> Size: Diamefer_� ------------------------------------Depth_ --- - ----------------Liquid Capacit ---:------------------------gals. <br /> j . <br /> y <br /> Privy: Distance from nearest well----------------I________a_.____._._____._.___..Distance from nearest building___-.-__---_-------_________..__.._.____. <br /> ---------------------- ----------------------------------------------------------------------- - ---------------------- <br /> Dis�ance to nearest lot line-----------' <br /> x I-5--ri ---------- ---VC <br /> Remodeling and/or 're'pairing,(describe):------ MJ4_i�G------$y__ _7_� --------FC R......E___ NG <br /> ------------------------------------------------------------------------------------------------------------------------:------------------------------------------------------------------ ---------------- ---------------- <br /> Ia._ I -------------:---------- <br /> ----------------------------------- -------------------------7-------------------------------------------------------------------------- --------------------------------------------------------------- <br /> ----------------------------------------------------- ------- --------------------------------------------------------------------------- -------------------------------------------------------------------- ------ <br /> 1 hereby certify that I have prepared this application arid that the work will be done in accordance with San J6aquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)- J4-�7 _ ---------- -------------- -- ----------------------------------------------------------- ---...--(Owner and/or Contractor) <br /> By:----------------- ---:.M1--=-------------------- <br /> ------------------------------------------------- ---------------- - --- - ---------------------- <br /> (Plot plan, showing size of lot; loction of ssfern in relation to wells, buildings, etc., can be placed on reverse side). <br /> t FOR DEPARTMENT USE O <br /> APPLICATION ACCEPTED BY---; --------------=-"----------------------------------------------------- DATE------- !=- �� -- �� <br />,• . <br /> REVIEWED <br /> ATE-------- <br /> RLVIEWED BY----- ------------------------ <br /> ------ ----------------------------------------------------------------------- ---------------- DATE----- <br /> WILDINGPERMIT ISSUED--------------- ---------------------------------------------------------------- ----------------- DATE------------------ -------- <br /> Alterations and/or recommendations: <br /> --------------------------------------- <br /> _-INV <br /> --------------------------------------*--------------- ------------- ------------- ------------ <br /> -------------------------------------•---------------- --- ----------------------------- ---- --------------------------- -------- --------- ---------------------------------------- ----------------- <br /> - <br /> ------------------------------------------ <br /> ------------ <br /> . ....... ... .. ... ------------------------------- -------------------------------------- - -------------------I------------- <br /> --------------------------- -- ---- --------------------- -- ------- ....... - ----------------------------------------------- ---- --------------------------------------------------- <br /> FINAL INSP - JO 0< <br /> 'T -------- - <br /> ECTI --- Date-----------7___ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> I. Stockton,California Lodi,California'"- Manteca,California Tracy,California <br />