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N-)K Ut-"U USE; . .P <br /> ----------- ----------------------- - --------- --------- <br /> I ------------ -------------------- --------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------- - --------------- -------------•------- <br /> ------------ ------ -------- (Completein Duplicate) Date Issued <br /> —t This Pe-­r­mitEx—Pire_s_TY4ai-FF­off-Dare issued --- --- <br /> - ----------- --- -------- <br /> Application is hereby made to the San Joaquin Local Health'District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCA ........ST I <br /> - ------------------------- ---- ------------------------ <br /> Owner's Name---------------- - ------ --------------- <br /> • --------- ------ --- ---- - ------ Phone---------------- <br /> Address_-,------------ 15r X -------------------- <br /> ------------- -S — <br /> i-----------jF-& r-09-4:10 A <br /> V ------------ ------------------ <br /> Contractor's Name---0jV_tj_j7=7:P <br /> -------- -------------------------- ------- --------------------------------------------- Phone.--------------------_----------- <br /> Installation will serve: Residence Apartment Hou'se L] Commercial ❑ Trailer Court 0 Motel 0 'Other <br /> ❑ <br /> Number of living units: --i---- kluml�er of beclro,;ms`_3--- Number of baths --/--.-'.Lot size 000 0 /-1-' <br /> 11� 1: 1 r----- -1------ ------- ------------------------ <br /> Water Supply: Public system E3 Cord.rrityri,itFST&m_0 Private PR"D <br /> epth to Water Table -Y,1? ft <br /> Character of soil to a depth of 3 feet-' Sand ❑El Gravel <br /> i _] Sandy Loam Ej Clay L'carri 21"t lay ❑C1 ❑Adobe [:] HardpanRf' <br /> Previous Application Made: (ifdate______._._.,_.____ - <br /> yes, No [�?_.-Mew ConstructiOM: Yes [- <br /> _] No �FHA/VA. Yes ❑ No <br /> TYPE OF INSTALLATION ANb SPECIFICATIONS: <br /> -No-septic-fank-or-resspool-pe--rrii+fed,if-pu6lic-sewer-is.availa6le--w.ithin-2ffO .i.ee+.).=--r P_ <br /> Septic Tank: Distance from nearest well_____.__.. - ---Distance from founHafibn _J------------Material <br /> rE50157-1 iri& No. Of compartments-------------------------Size---- ----------------- ----- -----Lq'u2l� 'ciep.fh---- ---- 'pacify------------------- <br /> ,�� II ------- ------- <br /> DiWosal Field: Distance from nearestwell <br /> ---------- <br /> -----Distance from founcl�ation-------t-----------.Disfance_to nearest lot-line.t.-I------- <br /> Nu��nber of lines., I gfh�_of <br /> -:---------7----------------------Len each line__.__._.__..-, !------------Width o-bfren_N'_ 'A" <br /> Ty e,oQilter material' - -Depth 0` 'filf� mlength------ <br /> ---- ----------------------- <br /> p -------------------- ...D f" 6r aterial............ h' <br /> Ir, ­., ----------_Total lengf <br /> Distance to nearest well_.._ t rll� <br /> Seepage Pit: ---------Distance frd "foundation-----/----0-, t&h6are'sf lot line------- <br /> P-1 ---------Distance <br /> Number of pits-A...... L�nin'g; rriafe;ial <br /> Size: 'Diameter---ffl_)(J�? e <br /> Cesspoo i ;` D -------------- <br /> Di I i �: 7: t I <br /> ' from nearest well Disfance from foundation-, <br /> stance <br /> El Size: Diameter __-.1ining material____.__-_________.___..________._. <br /> -------------- ----- ----�Depfh------ ---------------------- -----------Liquid Capacity. gal '. <br /> Privy: . i -------------------------- <br /> Distance' fromAnearAt well___------ <br /> -------- ---------- -----------Distance from nearest buiiding------------------------------- --------- <br /> ❑ Distancd to,'nearesf !of line ..------ _.;n <br /> e, <br /> ---------- - ------ -------------------------­­------ --------------- <br /> -------------------- ---------- ------------ <br /> Remodeling and/or-repairing (describe):---------------- -- - n <br /> 9 -------- i------------------ -----------------=-)------------------------------------------------------I-------------- <br /> --------------- ----------------- <br /> ------------------ ------------------------------------------------ ---------------------------------------i.......... <br /> -------- ---- -------------------------------------------------------------- <br /> -------------------- ------------------------------------------------------------------------- ------------------- ------------------------ ------------------ ---------------------------- <br /> -------------- --------- <br /> ----------------------------- ------------------------------------------------------�i------------------------------------ ----------------- ----------------------- ----------------- <br /> hereby certify thlat f-gave prepared this application and that the work will be done <br /> n�e in accordance with San Joaquin County- <br /> ordinances, State laws, and 'rules a9tid regulations of the San Joaquin Local Health Distrlcf. <br /> (Signed)__ <br /> ---------------------------_- ----(Owner and/or Contractor) <br /> Ry:------------------- ------------- - - ---- <br /> (Plot plan, showing sixepof lol location of system in relation to wells, buildings, etc ca <br /> -----f <br /> n be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCERTED �BY- 7- <br /> --------- --------- ---------------------------------------------1- DATE---- <br /> ---6 <br /> REVIEWED BY. <br /> ----------- -- ----- --------------- -------------------------------------- DATE----- <br /> ' - <br /> BUILDING PERMIT --------------------------------------------------------------------i` DATE <br /> Alterations and/or recommendations--------------- <br /> -=---- <br /> c- ----------------- ___---------------------------------------- -------- <br /> ------------*------------------------------------- - <br /> ------------ --------- -------- ---------------- --------- ---- <br /> -------------------- ------------- --------------------- -------------------- <br /> - ---- ------- ------ <br /> -"------------------------------------- ------ -------------- <br /> ------------Ir........... ...................­­-- -- -- ----- -- ------------ <br /> --------­n.- - - -------------------------- - ------------------------ - ------------ <br /> -- <br /> --- -------- <br /> ....... -- ---- -------- ------- <br /> --- -------------- ­......... 4 .. - - - -- --- -------------- ------------- -------------------- ------------ -------- <br /> -------------------- <br /> FINAL <br /> ----- ------- <br /> FINAL INS _B-Y: <br /> -- - -- -- ------- ate--- <br /> ` SAN <br /> te---` SAN JOAQUIN LOCAL HEALTH'DISTRICT <br /> 1601 E.Hazelton Ave.' 300 West Oak Street 724 Sycamore Street 205 West 9th street <br /> Stockton,California Lodi, California Manteca,California Tracy,cowo . T <br /> 15.1-1.9 2M 1-67 Vanguard Press rnia <br />