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FOR OFFICE USE: <br /> Ne �w <br /> --- ------ --------------------- <br /> --------------------- <br /> - - APPLICATION'FOR.-SANITATION PERMIT Permit No. <br /> ----------------- --- --- ------------------------- <br /> ------------------------------------------------------- aNico'mplefe',in-Duplicate)�. <br /> I --I C,� ---11*1 <br /> ---- ------- This Permit ixi .()Date Issued -----:71k_1143 <br /> --- -------------------- -- -------------------- pre�s"_-1 Y.Za�r_From'�Date Issued <br /> Application is hereby made to the San Joaclui-n-L—oca-]`H bT;TriFT6r-a- p6r-rTnif-t6,tonsttuct-En-d"in611-the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. A46N-T-F—C14, <br /> 0 :,F F14_v <br /> JOB ADDRESS AND L CATI ..... LIV T. --------I------ ------F.. ------ <br /> ._ _d-------HWY----- <br /> Owner's Name---------- --------------�SAW H_0__F_F=-- --------------------------------I---._. Phone----------------------------------- <br /> ................................ <br /> Address-------- 7 ------114 461 ................. <br /> ---------------------- "1_1V <br /> Contractor's Name_W_ - ---------- ------------------------------------------------- --------------------------........ Phonew'...."................. <br /> Installation will serve: Residence F1 'Apartment House 0 Commercial E] Trailer Court El Motel 0"6ther 0 <br /> ___-f_xj- = - <br /> Number of living units: -------- Number of bedrooms\3-- Number of baths _�---�Lot size W�-E---------------------------------------- <br /> Wafer Supply: Public system El Community system El Private Depth To Water Table ._g__ ft. <br /> Character of sail to a depth of 3 feet: Sand [ravel [] Sandy Loam Clay Loam [] Clay [] Adobe [] Hardpan C) <br /> Previous Application Made: (if yes,date-.__..__-__--.__._} No e New Construction: Yes 0-'6o 0 FHANA: Yes ®r' No [I <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-5 ---- Distance from foundation----/! .......Material.C9,WRETI=.....PRE_Z.F6 TB <br /> ?T No. of compartments-_____#7—----------Size.,'/X-"/­` X-57-Liquid depth__.._.._x_ -------------cap-acity__/_;?"12�_. <br /> Disposal Field: Distance from nearest well-5-D...Distance from foundation..../.0---------Distance to nearest lot I' =..... <br /> Number of lines......../--------------- ----.--Length of each line___---�O.Q_0 ' Width of trench------ ------ <br /> ..*/.. .7-------- <br /> k_Z;---- -0-------------- <br /> Type of filter Depth of filter materia ._A_____TotaI length------------_ <br /> K <br /> Seepage Pit: Distance to nearest well-----.----------------DistX 7from foundation_.mwm*mw4.-...,Distance to nearest lot line________......... <br /> . <br /> El Number of pits----------------- ---Lining material---- ------------------Size: DiametJr------------------ ....Depth-----------------I.............. <br /> T <br /> Cesspool: Distance from nearest well_____ __.Diistance from foundation-------------i------Lining material..__________________________________ <br /> --___ __Size Diameter--_--------- ----------------Depth------s---------------- -- -- -----Liquid Capacity----------------------------gals. <br /> ----------- ---- <br /> Privy: Distance from nearest well________________________________ Distance -f&o nearest building----------------------------------------- <br /> t --- ili6___ � 0 V 1-4 -------------- <br /> 0 Distance to nearest lot line_____________________ -- ----- -------I---------------- -------------------------------------------------------- ls� <br /> 5 <br /> ascl -----THI-45-------5X.1517F.tw---------------- <br /> Remodeling and/or re6i`ri;79Tdw'1 <br /> ---n9F------ - ---------- <br /> -------------- --------- —------ew4x,-------- ---------- <br /> Vj <br /> ---------------------FuRs-p-, <br /> --------- <br /> ----- --------------------------------------------------------------------------------------------------------------------------•---1---------••------------- -----• ------------­--------------­­--------------------------------------------------------------------------II'?- <br /> --------------------------------_--- ------------------------- <br /> 11 1 hw s, anrules anr-VguIafio]hereby certify that I have prepared this application and that the work will be done 11 in accordance with San joaquin County <br /> ordinances, State la � d r- 9s0pf the San Joaquin Local Health Distric <br /> -- - ---- Jqw _n o . ctorl, <br /> ------------------ ----- -- ------------------------------------------------------------ irk9ir a d/o�r,C ntra.- <br /> t (Signed <br /> �7 I ... ... r ----------- -----r- <br /> (Plot <br /> ..............____----------------_-------- ------------------ ----- -------------IL <br /> ----------- ----------m--------(Title)---------- <br /> 0, h <br /> (Plot plan. showing size of lot, lobation of system in relafe6n toL=Ils, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ..............I -------- ------------------- <br /> APPLICATION ACCEPTED BY e4.�------------------------ <br /> YDATE <br /> REVIEWEDBY------------------------------- ------------------------------------:--------------------------•-•-••••••-•—------------- DATE------------------------------- ............. ----------- <br /> --------------------------------�_ <br /> BUILDING'PERM'IT-ISSUED ' --------- _­-------------------------------- ---------- <br /> Alteraiii'o,Zan4/'o'r recommendations:-------------------- �____.-I---------- ------------------------------------------------------ <br /> ------. s---------- --JJ ----------- <br /> ----------------------------------I—------------------------------------------------------- -------------------------------------------------------------- --------------------------------------------------------------- <br /> ------------------------------------------------------- - ------------- ---- --------------------­ ------------------------------------------------------------------------------------------ <br /> ----------------------------------- ----- --- ------ - -------- --- ---------- ------ -------------------------------------------------------------------------------------- -------------------- <br /> D 6"-3 <br /> FINAL INSPECT ate----------�3.. .... 6_---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />