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�� F�vrril,t VJt: =— <br /> . APPLICATION FOR SANITATION PERMIT Permit No. <br /> 7�3 <br /> (Complete in Duplicate] <br /> " ' This Permit Ex ires i Year From Date Issued <br /> -- Dote Issued -72G�!� <br /> Application is hereby made to the Sen Joaquin Local Health District.for a l OS 4o-o y <br /> This application is made in compliance with County Ordinance No. 5 1permit to construct and install the work hbrein described, <br /> 3S k' AJ• �r-�E ,00 } �s- W i. So�rH D� L�voo.�/ ,�/ -oN FitiE <br /> JOB ADDRESS AND LOCATION...SOX.20 <br /> ?... ..�.>•NOEN. - �cuF.... �<aF--a�v N��c�_ o�y cvsr sip <br /> Owner's Name.------✓ a_4". _ ' <br /> ------------ ------ Phone..... <br /> 1 ...-...... <br /> Contractor's Name.....®.. <br /> -•-----•----------•--- ............ ................ <br /> i ---- --------------- Phone... ��^��Q <br /> Installation will serve: Residence Apartment House ❑ Commercial C] Trailer .Court ❑ Motel C] Other ❑ <br /> Number of living units: ...' . Number of bedrooms J Number of baths _-I_.._ Lot size ......._.42 <br /> Water Su Publics stem pp�� " ....--- ----- <br /> PPIY� y ❑ Communify system ❑ Private _ Depth to Water Table t7I�. ft- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ''Sandy Loam❑ Clay Loam❑ Clay ❑ Adobe X Hardpan C] <br /> Previous Application Made: (If yes date...___.... -_ <br /> i --.-) 'No New Construction. Yes ❑ No tf FHA/VA: Yes ❑ No �(TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permittedl <br /> -if sewer�sravailable within 200 feet.) <br /> Septic ank: Distance from neareir well:'!' ±--.Distance from foundation_.__...- _ Material...... t <br /> ❑ No. of compart4ents.:.-.r:.............�.-.Size--------------------- --- ....Liquid depth... ........... .Capacity (N <br /> Disposal Field: Distance from nearest well-___&a.........Distance'from foundation- /6Q_'-____._Distance to nearest lot line.../QQ_',. <br /> Number of lines_' ........ <br /> ��.. <br /> •-_-••-•--...._Length of each line....____.s.S-�'.•__-••-Width of trench"..-.__.���-_•-••-__---_ ",t,Type of frlter.material.t5.1Q�<'~1�_-Depth of filter material........ ��-.__Total .length........._......:...... <br /> �...`n <br /> Seepage Pit: 6! <br /> Distance to nearest well from foundation...._ -•......Distance fo.nearest lot line_______ __ <br /> to Number of pits...�._/-.-I.-_•.-Lenin mafieriel__�,- -- -•- <br /> 1 g �E-/�Size: Diameter---•---��-ef''.w--Depth.I.........._.��___ ..... <br /> Cesspool: Distance from nearest well.................Distance from foundation.-;..... ...Lining material._....I................ <br /> .- <br /> ❑ Size: Diameter------- ...;?!..-� <br /> Depth......... •-•---••................. .... "':='"'Liquid•Capacity.`'---••-------- <br /> Priv . � , . ........gals. <br /> Y' Distance from nearest well......... .................. .Distance from nearest buildin�j:__-_, , <br /> Cl Distance to nearest lot line.------ . ..---•• <br /> + � I r <br /> --------------- <br /> 'r -- <br /> Remodeling.and/or repairing (doscribe):_..._... �...._� <br /> •----- <br /> ---•--------••----••-•...•---- . •-•--=-- [ ... --- <br /> ----,��---..r......_ .. <br /> - �,,., <br /> ------ ............................. ..... <br /> ---............................ ----'-------==-----------------------•--•---...-----•--.•........--------------------------_;-------------------•,-------------------------C-r--• ----...---............ ........ ... <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, Stafe laws, and rules and regulations of the San Joaquin Local Health District. I <br /> e , <br /> (Signed) t <br /> 4 :--•..................•----.....----------_ _(On per and/or Contractor) <br /> ' (Tit e)--- �.. <br /> (Plot plan, showing size of.lot, locate n of sysfiem in relation to wells, buildings,•ete.,,can;be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.....- --- _ - Q i i <br /> ....... .. .. ...... �_-- --------- ------•- -- DATE_.-..7 -c� <br /> REVIEWED BY... .................... { --- - ........ ------ <br /> BUILDING PERMIT ISSUED-------------- --------- <br /> - --- ----).---- • ..... . DATE <br /> ....:....--•- ............... ----•------ ........ ---- <br /> Alterations end/or recommendations:_......? - '- tr': ATE.......... =------------- --- <br /> ................. <br /> ................ <br /> :.................................•-------------............................ <br /> .... -------- i" l s l <br /> ...._.................................•-•••----I........._. . <br /> ............... <br /> . .... ......... .................................................... <br /> FINAL INSPECTION BY:...... . ..... '� t'- --•�.... <br /> Date l- , <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellen Ave. 00 West Oak Street <br /> 144 Sycamore Street 20S West 9th Street <br /> Sleeklon,.California Lodi,California Manteca,California <br /> Tracy,California <br /> [8 9 REVISED a-59 7M 3-'63 F.P.CO. •- <br />