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FOR,OFFICF, USE: <br /> ----------------------- -------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. Z..� <br /> /�-� y <br /> .. ........------------------------------------------ (Complete in Duplicate) <br /> Date Issued 72 <br />_f__S­7Zgr__ -A -�rX_L>�--Aj... This Permit Expires 1 Year From Date Issued - ,/S- <br /> j_0ee I 9?�ory <br /> Application is hereby made to the San Joaquin,Local Health District for a permit-`t6 construct and install the work herein described. <br /> This application is made in compliance with C66nty Ordinan'ce No. 549. <br /> JOB ADDRESS AND ILbCA I N--------Nopnai -.-AvF..........7_& <br /> Owner's Name <br /> =?- ------------------------------------------------- ---------- Phone--------------------•--------------- <br /> -----------Y_ <br /> Address------- .... 1-Ti.......-3---------- -----------mr -=---------•---• --------------------------------------------------------------------- <br /> Contractor's Name-------- --------0-W&F-E----------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence E] Apartment House E] Commercial 0 Trailer 44w* dMotel El Other E] <br /> Number of living units: ---)!.. Number of bedrooms Number of baths -1---- Lot size _____________________ <br /> Water Supply: Public system El Community system Private [I Depth to Water Table --IT- ft. <br /> Character of soil to a depth of 3 feet: Sand 2__Gravel E] Sandy Loam El' Clay Loam El Clay E] Adobe E] Hard <br /> Previous Application Made: (if yes,date--------- ----------) No g]-- New Constru,ction: Yes Vj-'N o E] FHA/VA: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ) <br /> (No septic tank or <br /> cesspool permitted if public sewer is available within 200 feet. <br /> Se nk: Distan-ce from nearest well-----iS7 nclati6�n----- ........ --------- .......... <br /> ....Distance from fou <br /> No. of compartments--------- ---L----------Size--! .,X _,57---Liquid depth ---- tv <br /> Septic <br /> Disposal Field: Distance fro A m nearest well.___--S�_O----Distance from foundation___. __ _----------Distance to nearest lot line-_5�_ <br /> Number_ <br /> u o <br /> N m efi7e_s'�� ---- -- <br /> ------ -------------Length of each line___,1_6r-----_ --------Width of trench_____2y---1- -------,­ � <br /> Type of filter maferial__R_ Depth of filter material....../,�-----------Total length...... ------------15-0------ <br /> lot line-_ <br /> Seepage Pit:� ,Distance to nearest well-------------- ------Distance from foundaticn- ------------------Distance to nearest <br /> El Number of pits----------------------Lining material----------------------.Size: Diameter----------------- -----DeI!ih------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from found 1!ation--- ---------------Lining material-------------------------------------- <br /> Size: Diameter---- ------------------------r-------De fh-.----------------------- --- --------------- -------Liquid Capacity___--------------------gals. P <br /> 0 <br /> Privy: Distance from-nearest well_____.___.___,_.._-------------------------- -Disfance from nearest building_.___!__.._____-------_--___..._...___.._ <br /> 0 Distance to nearest ]of line--------------------------- ------------------- I-------------------------------------------I-------------- <br /> Remodeling and/or repairing (describe)--------------------- -----------------------------------�,__I_J�-------------------------- -------------------------------------------------------- <br /> -------------------------------------------------------- <br /> ------------------------------------------------- ------------------------------------------------------------- ------------------- --------------------------------- <br /> ;. I <br /> ------------------------------------------------------------------__---------------------------------------------------------------- --- ------------------------ ------- ----------------------------------------------- <br /> , 1 <br /> --------------1: ---------------------------------------------------------------------------------:----f 4--------------------- ------------------------------I---------------------------- <br /> cr <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 /> State <br /> 'c' c <br /> (Signed)--- ... ------- - ............. ------------------- ---------------------------r------..(Owner and/or'Contractor] <br /> -------------(Title)--------------- --- ---------------------------- ------ ------ <br /> By: ------------------------------------------•• ------------------------------------------ ---------------------------- <br /> .(Plot-plan.,-skowing.size-of,lo+,-Ioca+ion of-sys+em.-in,rela+ionto.wells,,buildings-efe...:can 6e-placed.on.reverse-side).—. - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----------7_7�-R-0--------------------- - -- ---------------------------------------- DAT ------ <br /> ------------------ <br /> REVIEWEDBY-------------------------------------------- -------------------------------------------------------------------------------- DATE------......------- --------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.__:.------------.---------- ------------------------------- <br /> Alterations <br /> ATE.-_-:.------------ ------------------------------------------ <br /> Alterations"and/or recommendaf ions:------------------------------I--- ------ -------------------------- --------------------------------------------------------------- ----------------- <br /> 11" - <br /> ------- ------------------------t)Q�� <br /> ------------------------------- -------------------------------------------------------------- --------------------------------------------------------------------------------------------- <br /> ------------------------------------------------- ---------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- <br /> ---------------- ---------I------------- ------------- --- -------------------------------------------------- --------------------------------------------------------------------------------- <br /> ----------- ------ ---------------------------------- - ------------------- ---- <br /> .......... ......... ......... <br /> - a92 7 --- ---- <br /> ----------- <br /> FINAL INSPECTION_5)�,,�_- --- ---- Date_... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca, California Tracy,California <br /> F.P.120. <br />