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FOR OFFICE USE: <br /> r c- <br /> E ------_ - APPLICATION FOR SANITATION PERMIT Permit No. _..7----------------- <br /> t <br /> (Complefe-in Duplicate) <br /> } <br /> Date Issued Date Issued -27: _=_T� <br /> __ This Permit Expires 1 Year From at _ <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 ounty Ordinance No. 549. <br /> JOB ADDRESS A `OCATIO �'��` ----------- //7/-7o--,Sr--- .- --rn-- ------ --------`- _ <br /> Owner's Name------ i 1 - ------- --------------------- ] -,-------------------- ----- Phone <br /> -------------------- <br /> Address------------ ( J-__-- A_------------ �" ------.�a�i -".�. C-F��� ._�� ..._... <br /> d, ( Cha ._ <br /> Contractors Name-----nAro_ ..i f-1'�-�,,' .---- --- -- ---•- c -6 VV" -------- Pirrone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M tel ❑ Other )] <br /> Number of living units: ______� Number of bedrooms� _ Number of baths� Lot-size __.'; i ce s.................... <br /> Wafer, Supply: Public system ❑Community system [_1 Private Depth to Water Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay,Loam ❑ Clay ❑ AdobeX Hardpan ❑ <br /> Previous Application Made: (If yes,dot e------------------. ) No�p�` New Construction: Yes j No E] FHA/VA: Yes E] No <br /> '�"�`TYPE`OF'INSTALLATION AND SPECIFICATIONS: V <br /> l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r Septic Tank: Distance from nearest wellYft.9--.-Distance from foundation________..._..Material.---_ ------ <br /> _-- <br /> _.__. <br /> No. of compartments------___________________Size_ .'_120.0-_._._-_Liquid de th......... ... .. ....... Ca acity. ---- <br /> I <br /> • i <br /> Disposal Field: Distance from. earest well....___._Distance from foundation..... ............Distance to nearest lot line................. <br /> Number of lines.._---�__-. Length of each line__ of trench_._.o�.. _._�___________.__.. <br /> Type of filter material._._-----t-2..__-______Depth of filter material_________________Total length_"-"_�..�®- _-_--"-""-- <br /> Seepage:Pit: Distance fo nearest well----1.--•_-_�_--._.___Distance frpm foundation_--- : � <br /> ..___._Distance to nearest lot line �."_-____.._ <br /> Number of pi¢s-_- ��_. Lining material---_j_.1 ....". Size: Diameter-- .� Depth_._.__1.c ---------_"._.____- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation._..-............ ..Lining material------------------------------------- <br /> El Size: Diameter-- ---------- -- ---- Depth---------------- ............................------Liquid Capacity----------------------------gals. <br /> .� F -- --- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building."--__._____._--.____---_-__.__-_.._. <br /> ❑ Distance to nearest lot line-------- -------- - - ----------- -----•---L------------------------------------------------------------ <br /> Remodeling and/or repairing (describe) ---- - --- ---- ------ --- -------------------------------------------------------• --- <br /> ---------------------------------------------------------------•-------------------------------------------------------------------•--------------------------------------------------- ----------------------- <br /> I - x - � <br /> ------------------------------------------------------------------ - ---------------------•--------------- ------------------------------------------------------------------------------------- ...... <br /> tI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law an ules and regulations a he San Joaquin Local Health District. <br /> (Signed) _ --- (Owner and/or Contractor).r <br /> ------ --- <br /> im <br /> By:--- M•�--- ---------------------- -------_---------- ------ ------------- ------__r <br /> ----- : --(Title) - -- ------ -- .._.._.--- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,etc., can be placed n reverse side). <br /> { FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ------------ -------------- ---------------------IDATE----- - 1�'r ------------- <br /> REVIEWED BY------------------------------------ ---- -- - ---------------------- ------ DATE----------- --- ------------------------------------------- <br /> BUILDING PERMIT ISSUED-------- --t------ ------- ---------------------- ---- ----------------------- ---- DATE--------------------------------- --------------------------- <br /> Alterations and/or recommendations: - ------------- ----- ------ - ----------------------------------- ---------------------------------•----------------- -------- <br /> ----------------- -.----=-VT' � -7 <br /> ---- <br /> ----------------------- ------ -- -- -- -- ------- <br /> FINAL INSPECTION BY: -- -- ----.__-- .--- ---- ------- ----- ---- Date------- <br /> ---------------.__-- <br /> `/. <br /> i <br /> SAN JOAQUI LOCAL HEALTH DISTRICT <br /> f <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Server <br /> Lodi, California Manteca,California <br /> Stockton,California [;',� Tracy,California <br /> E.H.9 2M 1-67 Vanguard-Press <br />