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FOR OZFICE 4SE: <br /> �. . <br /> --- ___________ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .....1� ---___. D------------- -------------- -----------•-'-•--- -------- (Complete-in Duplicate) <br /> ----------- -- --- - -------- This Permit Expires 1 Year From Date Issued Date Issued ___ z 6-f <br /> C L? 7- 12,0 _,3 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her�n described. <br /> This application is made ino p iance with County Ordinance No. 549, <br /> A4 TrI f+ <br /> f ` <br /> JOB ADDRESS AND L ,C ION---C—i kf B1- -l1I]� <br /> - --- <br /> Owner's Name--------------- L RC, <br /> -- ----------------------------- <br /> ------------'------------ Phone------------------- <br /> - - ------- --' ------ A---�------' --' <br /> Address-----------------•-------- <br /> M-r <br /> - • - --- --- -'-•------------------------.._-... <br /> Contractor's Name------±7�+�N , # 1:. l r'_t r=�wr ' ' _ <br /> r _ <br /> _ - _ -----------•-------- - _ _.-. Phone-- <br /> _ _ _ ----------------- <br /> Installation will server Residence ❑ Apartment House ❑ Commercial ❑ Trailer S� [ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms ___2—Number-of baths ----- Lot size ---- ___ ____ �o t ._--------------- ,- - <br /> Water Supply: Public system ❑ Community system ❑ Priva` e Depth to Water Table la ft I <br /> Character of soil to a depth of 3 feet- SandGravel-❑T S'a dy�Loam ❑ Clay Loam I]. Clay ❑ Adob"e ❑ Hardpan <br /> Previous Application Made: (If yes,date_........... ... 1 No,&! New' Construction: Yes: o ❑ FHA/VA: Yes ❑ No <br /> TYPE.OF INSTALLATION ANDSSPILCIE[C-ATIONS:x - <br /> - �' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee#:' 1. @; <br /> Septic T Distance from nearest well.__ -__ Distance from foundation`L. f--- ----------Material ....C-0_NC-'RP rte__--,.-. � <br /> Disposal e}d: Distance from nearest wel `7_Q SizeX.� ` --__Liquid depth..-��Z. Ca pacify <br /> 0 :_• `�I' <br /> No. of compartments s................. <br /> Distance from foundation-` _ `f (� <br /> 1�.i.:_._-_.Distance to nearest lot line._____--y__-______ <br /> T <br /> Number <br /> e of filter flinmaterial i�r�C�- Length of each line_j!�} ._ -' Width of french____--.2 'r r . <br /> YA _ _ _ _-_-.Depth of filter material_- -.Z _ Total length_ -_ ---------------- <br /> Seepage <br /> -----_-------Seepage Pit: Distance to nearest well:1_"_._ . ._ -----Distance from foundation <br /> ----:_._---------- Distance to nearest lot line_________________ <br /> ❑ _ �,Iumbe . of pits.:- --------------- Lining material.-------------------- `Size: Diameter Depth ' <br /> Cesspool: Distance.from nearest weilf------------------Distance from foundationr---------------- ._Lining material________________________ i <br /> ❑ S'iz&-''Diameter- -- ----- -- - ------- - q Capacity - ---------gals. <br /> �- - -----'--- Depth------- f' ��---- ` Liquid Ca gcit - --:------------------------------- <br /> ------- <br /> -------------------- --� <br /> Privy: Distance from nearest wefl__ _______________ ___ :._-._J.___�____Distance from nearest.buildin <br /> ❑ Distance fo nearest lot line -!------------------------------�---,--__.�____------ <br /> s <br /> Remodeling and/or repairing (describe):.--------'----------------------- -'- =----= <br /> k --------------------------------•------,_,----------------------------------------------- <br /> ------------- <br /> --------_____--------------- <br /> --------------------- <br /> _____ <br /> I hereby certify that I have prepared this application and that the work will`be done.in.accordance with San Joaquin County <br /> ordinance,_S#ate laws, and r I+es�nd regulations of the San Joaquin Local Health District."" <br /> (Signed)----- - . . <br /> --- ' <br /> _ ... ..- �. -------------------- ----- - - Contractor) <br /> ------ <br /> ---- �•�•-- -- _ _-- ` _.(Owner <br /> i.. :_ --- --------------- <br /> - -' - :--------,-_(Title} ;'- ... -..._....--. '---- _.. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> f j <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -I"R- mm -w _" - - '�- m_ - _ <br /> REVIEWED BY------------------- ------- -- a • DAT=, <br /> E ' <br /> € E.- �j <br /> BUILDING PERMIT ISSUED-------- -- - '-•---------------------------------------------•--------------------------------------- DATE-_:,- = <br /> ------------------••------------ s <br /> Aterations and/or <br /> ' - recommendations:mme_ndations:_.-...-.____..__.---_--.__-..____-.__ <br /> - -_-_--- _ <br /> --- <br /> ---- <br /> x ----------- if i• JR ------ ---- ----- ---•--- ---- <br /> -----' ------- ------•- _ <br /> 1 y. <br /> --------------- <br /> ----------------- __ -_ ____-_- - ._ ------------------------------------------------_ ___ ______.____.-.._ <br /> 7 -.___ _ _ .-.- <br /> FINAL 'INSPEG-T4QW--B�1� i ,%'1l✓7-' ' Date- ' - ------------ <br /> -.:_ �---- k <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ` <br /> 1601 E.Hazelton Ave. 300 West Oak Street } 124 Sycamore Street <br /> 20.5 West 9th Street <br /> ' -a <br /> Stockton,California LodManteca,C6lifornia <br /> Lodi, California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press x <br />