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FOR OFFICE L&SE: <br /> ------- <br /> - -- ----------------------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. <br /> - - --- ------------- - - (Complefe-in Duplicate) / r/ <br /> __.._- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District far a permit to construct and install the herei scribed, ' <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------------------- /-< ifE_ f_1ff?RT-1L� r s <br /> .R <br /> /�/j �f <br /> Owner's Name---------- __eL B R"T---•---l'-l- _FN-Z_t_L --- - ----------- ----- Phone <br /> ----------------------------------_:�- - .. l12- <br /> --------------------------------- <br /> ------------------/► 7`CF} ---- , <br /> Address--------------- ,.. <br /> Contractors Name Q_W_tj.i`.h -------------------------- Phone---------------------- <br /> • C�'AP -------------❑--------- - ---------------------- ----------- <br /> Installation will serve: Residence artment House Commercial [I Trailer Court ❑ Motel [-] Other r] <br /> ✓, r <br /> Number of livingunits: _ Number of bedrooms Number of baths__ Lot size __ <br /> 7R -=----- --------- - <br /> Water Supply: Public-sys+em't❑ Community system❑ Private`�Depth to Water Table/ ft <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy, LcFam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ i <br /> Previous Application Made (If yes,date------- _-.__---^j} , Nqd� NewiConstruction: Yes o ❑ FHA/VA:_YeDNo ❑ <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.CD ` 4 <br /> Dista ce from foundation______ ___--------_.IvlatrAal ---_______. <br /> " No. of compartments_. `.Size_. :� __x_ ___'�iquid d - 7Capacity_��� <br /> Disposal Field: Distance from nearest well___ --'_Distance from foundation___,Z0-___--_-Distance to nearest lot line-_-`----- <br /> Number of lines---------:___�_ ___________ ____Length of each line__.______ -._�� __..._______Width of trench.-.-_.-:_._ <br /> 9 - `�-------,. <br /> y <br /> Type of filter material--1 e.0 .-.:.-Depth of filter materEai___--_I_ _______._.-Total length----------_____z��.0-___:____..... i <br /> Seepage Pit: Distance to nearest well___________________.._Distance from foundation______N_______-__-.Distance to nearest lot line----------___-___ <br /> 'r ❑ Number of Efts--- -----------------Lining rmatocial-- .-'-,-----!""""S ze s Diameter------ -----:Depth-----------------------•--------- <br /> Cesspool: Distance from nearest well ___-------______Distarice from found'ation_-__`--_ ining material---____-______-_____-_____.. _____-__. <br /> ❑ Size: Diameter- -- -------------- ----------------Death- --------------------- �---- Liquid. Capacity------------- -------------gals. <br /> Privy: Distance from nearest well______________________________________________ __Distance fromnearest building_.T <br /> _._. <br /> F-1Distanceto nearest lot line ------------------ -------- - ----------------------------------------F- ----------------------------------` <br /> l � E <br /> Remodeling and/or repairing (describe):_____ - <br /> I , --------------------- <br /> } <br /> - W ��'L�x1�1I=---------oI US� W, �T`t - ��rA_�-L�f��� C'(��N�I✓ <br /> -----•-------- ------ ------------ <br /> r --3 ✓e%,. � `l vim 1 -'vS 1r-1C; <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, tAls,qndd s and re. Mations o he San Joaquin Local Health District. <br /> (Signed) -- -- -- - ---- ----------------------- ----- t`. ............(Owner and/or Contractor) <br /> _.. _ <br /> By:-------------------------------- -------•-• ---------- ------ ------------- - --�'r-`--- -----------------------------(Title----------------- i <br /> (Plot plan, showing size of lot, location of system in r ation to'wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ^k-!1�- DATE ~' <br /> - - <br /> REVIEWED BY-----,-------- <br /> ------------------------------- - <br /> ------- -- -------•-------------'--------------------- ------ DATE----- ----------------------------- <br /> BUILDING PERMIT ISSUED-------- -- ------- -i------------------I---------------------- DATE--------- - <br /> Alterations and/or recommendations: --------------- ------- ------ - ------ -----------------•-- I` <br /> -•------------ -----•-- -- <br /> _____________ _________________ <br /> ________________ ----------------- C <br /> FINAL lNSPECTIC ------ --- Date z�� `..- __._. --------------- -----•-- i <br /> I' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT i <br /> 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> � I <br />