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I-UK UFFICE USE: <br /> -------------------------------------------­_-------- <br /> ----------------------------- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -1 ,C <br /> ------------------ --------- ---------- --------------- (Complete in Duplicate) ��3 <br /> -------------------- ------I..... - <br /> This Permit Exeires I Date Issued <br /> Year From Date Issued <br /> Application-is-hereby,made,,t.o-the-.Sen Joaquin Local-Heal+h—"'JiPELf for75 4?m4*4cons nd�irts-tallthework-herein.dep$;ribed. <br /> N­ <br /> Tk�jplicafioni-is-made in compliance wi-t h o"' TDist r <br /> unty Ordinance 0.r 549. <br /> t -C.a_ r4-0E_-r , . -el <br /> JOB ADDRESS AND LOCATION-------Zay._Isa--------q....M.C.-HIN - ` /--- -,2- L,9THRof, <br /> j LE'>--- ------ -------------------------------- <br /> Owne(s Name_.__ ---Aut---------- <br /> -----------------jm------------ <br /> --------------- Phone'T --- --- <br /> ----------------- <br /> -------------------- <br /> Address----- <br /> Contractor's Name-------- W_ (4 _ <br /> ----------- --------------------------- ------••-------------;.:..-----. <br /> - ----- <br /> Ouse L] C -------- Phone................ ........ <br /> Installation will serve: 'Residence Apartment Nouse' 4 --------- <br /> Commercial ❑ 'Traile'r, Court El Motel 0 Other [I <br /> Nu.mber of living units: Number of bedrooms 3-- Number-of baths ---i--- ot size <br /> . ................. <br /> 'fir Supply: Public system [j ConWmunify s�y,, em <br /> yy ❑Private E] Depth <br /> Wa li-' to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand WGravelr[] ' <br /> 46.; Sanclyr.Loam E] Clay Loam [:] Clay 0 Hardpan [] <br /> Previous Application Made: (If -----------)_ No New Conitruction:' -Yle�' No 0 FHA/V Yes E] �No.Fr, <br /> V1 7. it . A <br />�-�i;i-�TYPE OF-INSTALLATION-AND-SPECIFICATIONS:.--.,,,-.. <br /> (No septic tank or cesspool p6mifted if public sewer isavailablewithin 200 feet.) <br /> ,77 <br /> eptiq Tank. Distance.from nearest we LE <br /> S <br /> -----Distance from founclation.'__10... Mat I <br /> T2 <br /> N. <br /> 0 of compartm6nts---------�_7, ---------- Liquid d <br /> ---------Capacity---- ------ <br /> SUL. <br /> Disposal Field:' Disfan4e.from nearest well.-3- -_---Distance from fo�nclati <br /> on____!7_.__.Disfance to ri R.-est lot line <br /> f ea __�,�)--------- rh <br /> mbe -------Length of each li� ;Zq a <br /> N u of lines-1---- ---------------- ch line----- __f�W of trenc <br /> ---------- -------------- <br /> Type o fitter ma`ferjal_6i.LR-0_CY'--Depth of filter <br /> 7 <br /> Seepage Pit: 'Distant e to nearest well.____ from 'foundation------------- ';Distance to nea'r'est lot line-1 (41 <br /> x - ! <br /> 1-1 Number Of Pits-- --------------- Lin"' t rial <br /> Ing ma e A--------------------Size: Diarneter_�---IP------ --------- ----------- <br /> ----Depth----------- -----W <br /> Cessp of: I I ii------ <br /> Distance-from nearest weft___.__ from foundation--------------_----Lining material.------------------------------------- <br /> El <br /> Size. Di meter.-____-- <br /> .-.-.--.--Depth,--------------------------------------------------Liquid Capacity------------------ -------4A. <br /> Privy: <br /> Disfarice.,frorn nea st well OT <br /> A % I <br /> ----Z7--- -----------______Distance from nearest building-- <br /> ------------------ ----------------- <br /> ❑ <br /> Distaq,ce to nearefsf lot line------ ------#T r <br /> ----------------------------------I---------- <br /> Rernol ling and/or repairin <br /> cj (describe} +r - --------------------------I------------------_ <br /> ............--...-------•------------------------------- <br /> ------------ --------------- ------ --------4�------------- • ------------------------------- <br /> --------------Z ------ --------- ----------------------- ---------1-1--------- <br /> f <br /> --------------- <br /> ------------------------------------------I ---------------------------------------------------------- <br /> ------------t----- ------------ ------ <br /> ---- --------------------- ---------- ------i---------------------------------------------------------------------:------------------- <br /> .F-11 ------- <br /> -----------I----------------------------------- <br /> I f1hereby certify.f W I have prepared this applicaf ion 7 . - <br /> -and that the work will'6e done,in accordance-with San Joaquin County <br /> ordinances. St Oe-----------la-----"--. and <br /> rules rd <br /> ! rogtlifions of--f-h--e---:-S--a--n---J--o--a----quin Local Healt-h- District. <br /> . . <br /> (Signet) LV <br /> Nr 7 -- <br /> --- <br /> -----------_------O---w---n--e--r-- <br /> and/or Contrado <br /> plof <br /> pla6.,showing sizeoflot, location of system.in relation.fo �wells, buildings, e ' <br /> etc., can bojpk�ced onreverse side).', <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__---- <br /> -------- -------------------------- ------------------- DATE. . ­­:­ -----I--------------------- <br /> REVIEWED BY------------------------------------ <br /> --------------------- DATL_, ----------------I------------------- <br /> BUILDING PElrMIT ISSUED_: <br /> I *0_� ----------------------------------------------------------------------- DATE............ <br /> Alterationsr and/or recommendaf ions:4 i- -, V ----------....21------------------------------------ <br /> ----------- ------L......................*.......... fl- <br /> .......... ------------------------------------------------ -------------- --------- <br /> --------- ------------- -------- -TA-N_K' ------0_._K_�----- I _� <br /> ---------V_ .1 - - _..; --------•---------------------- <br /> I <br /> ------------------------------ ---- ------- --------------------------:------------------------------- <br /> ------------------------------------- -----------1:--------- ----------- <br /> r ------- <br /> j -----A-..... . ----- ------------ <br /> I qN.'rA. --------- ------- ---- ---- ---- ------------I--------------------------------- ----------------_------ -------------------------------- <br /> ------- -------------- --------- <br /> 4-- -- ------------- - ------ -- --- ----- - ------ - - -------------------------------------------------- ------- <br /> ------------------------------------- <br /> Date---'.-:---- -------- <br /> FINAL INP ION t� I�ON' BY-. ------ ----- <br /> 7W Ir <br /> V ----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E6.9 pEyig EO e•59 F.P.CD,2M&.-60 <br />