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FOR OFFICE USE: _ <br /> - �--�----'- -�- APPLICATION FibR SANITATION PERMIT Permit No. ..tztl/__� _- <br /> ........... .......3.. ....... <br /> ......r� ,., L � (Complefe.in Duplicate) Date Issued jo 7'?�� <br /> This Permit Expires 1 Year From Date Issued <br /> . ` q • - p O <br /> y; Application is hereb}r made to the-San Joa utrr Local'Health District fora permit�°�nst .ct d insfaN'•,the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ( S'� 2`f U��AAAIVA <br /> f33�5�,4, <br /> JOB ADDRESS AND LOCATION_ NL�____eDAD.......4,8"X.... ..�t-L-----$-- SO� 0� R- <br /> Owner's Name......5;F.R g,P_F-TT je_.��r_A-4:�y---• ....... Phone <br /> Address !..IZ. _�.> .F?�3C.. _ -- --L 1_/11AA7V-----.-.-C-AZ-�--••-•------•----------------------•------- <br /> i nn tt� /� f <br /> Contractor's Narne.. •-••` .dl*s� .� 1-.....__�. _ !.. .. ..... .....--............... ................ hone �l.(y.{�lp.0. <br /> lns+alto+ion will serve: Residence ❑ Apartmento 11, �seZ❑Commercial ❑ Trailer Court ❑ Mot iI ❑ Other TiPAILE.�, <br /> _. Number .f bedrooms'- Number of baths �USI° <br /> Number of living units: 1...... • +r � d Lot -00 <br /> -Q-. �..-•------ <br /> t Water Supply: Public system <br /> ❑ Commuriitj system n Kivate O�Depth to Water,Table1QQ ft. <br /> Character of soil to a depth of 3 feet: Sans ❑ Gravel� ] Sandy Loamy Clay Loam Clay❑4 Adobe❑ Hardpan ❑ <br /> N- }f a li I <br /> Previous Application Made: (If yes,date..... ....:........ 'No New Construction: Yes`�(, No ❑. FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION XND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 2 feet.) r <br /> r t <br /> ii.Jl: .:M terial-.. . - <br /> Septic Tank: Distance from nearest weil__,�V...-- Distance from foundation__., ,,�� rr <br /> No. of compartments.._.�-------------------Size_._J�j......__.....Liquid d tf%�.���.� ._..-Capacity.--$ --......._�... � <br /> •W. , <br /> Disposal Field: Distance from nearest well_�70........Distance from foundation.11. .-.._....Distance A nearest lot line..~.......... <br /> � ,,�,..'N.umber„ofxlines _ L.en thxof.:each+lina.....u•.. _—'Wid'th*o drench__-__`,�. ..0 <br /> TYp,Vof filter material... _ .......r....Depth of filter material-------.a�-�--_'.._.Total len .1h.. ...fD...............`--._ <br /> i t` .._.___..Distanci to nearest lot line__..._.... <br /> Seepage Pit: Distance to.nearest well.../OP..­_" Distance fr m f ndation-_. <br /> Number of pits._Q�.0.1_-Lining material... Size; <br /> Diameter..._3. .._.....:.Depth_..._w�.S.� 1 <br /> j Cesspool: Distance from(nearest well__.._.......__.. Distance from foundation------------------ Lining material_-_- •--gals, <br /> ❑ Y Depth Liquid Capacity... .................Size: Ciameten-_-------------- ----. <br /> Privy: Distance frominearest well. <br /> .........................................Distance from nearest building---------------•--------•---- ---... <br /> ❑ Distance to nearest lot line.... ------------------------ ..........__....__...._. ..... <br /> l ; i/ �� <br /> Remodeling and/or repairing (describe):...a/Jr- <br /> _.....-•................- . ---...----...-- .... <br /> --••----------------------I.................... ....----------------•...................................------------......... •....--------.............---------...... <br /> I hereby certify that 'les <br /> ve preparod this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, a and regu Lions of the San Joa n Local Health District. <br /> ~ .. ... (Owner and/or Contract <br /> (Signed)---------- • (Ow d/o or) <br /> -- ---- <br /> _{rile)------ <br /> (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be plat on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> ` B .- DATE- - `2 7;7-07 <br /> I _ APPLICATION ACCEPTED BY __ lc".�..... .-••-•..---••-. <br /> REVIEWEDBY................................................... DATE......... ---- --------------------------------------•--- <br /> BUILDING PERMIT ISSUED----------------- ------ -..------_ ............. DATE----.---------- ----------------- - --- ------------- <br /> Alterations an or ecommendations -••-----............................••-----.........--------..._...--------.................... _ ... . <br /> ........................ .... •-------------- ----•----- ......... ............................................. <br /> --141_.a-. <br /> t <br /> -lam..._:.. �'---.....__...---•......._......__._........_ <br /> i <br /> FINAL INSPECTION BY:......... Date...... — -1� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 west Oak Street. 124 Sycamore Street 205 West Soh Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.Ca. <br />