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FOR OFFICE USE: �* <br /> �,°3 <br /> _. -------------------------------------.- ------------ AerLICATION FOR SANITATION PFRWT Permit No. ,.lP_.*``/-2 <br /> ........... -------------------------- ................. (Complete-in' Duplicate) <br /> -__-.--_- This Permit Expires j-Year From Date Issued Date Issued <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. t <br /> Ile <br /> t <br /> JOB ADDRESS AND.LOCATION_-. s -xY _.�-_ _ ..__2"_ <br /> ..... s "I�•��Owner's ame--- �:� 7 - c �� ------� `� °--------- - --------------- Phone....................................- <br /> Addregs- A' �_k <br /> o11 ontractors Name -. � - � -1 -- .-------- ---._. <br /> -- <br /> Installation will serve: Residence ❑ Apartment House.❑, Commercial Tr'a li er Court Motel ❑ Other ❑ { <br /> i { g 21.10ww �I_ -------------- ---- <br /> Number of livin units: __ _____ Number of bedrooms __-.__._ Number of baths�____.._ Lot size _... <br /> Water Supply:' Public system ❑ Community system ❑ PrivateX Depth to Water Table �"?ft <br /> Character.of soil to a depth of 3 feet- Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ : Adobe Ha dean ❑ <br /> Previous Application Made: (If yes,date---------- . 1 No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No s tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r :gyp Distance from nearest well-----------------Distance from foundation------------------- <br /> r 44' 1 . .._ Materia.l .__-_--_--_...._--_---- <br /> --__.__-_______--._-_-_. <br /> No. of compartments.............. ..---- -- _Size_____•____ _.----- -----------Liquid de th_..____-. �-......Capacity------ ---------------- <br /> Disposal' <br /> .} <br /> Distance from nearest well_ __.__Distance from foundation___ t --Distance to nearest lot <br /> Number of lines_ f __ _ <br /> t Length of each line. -_ _. _._ Width of trench____r .._.__..__._.____ <br /> =Type of filter materia A`---- ..._Depth of filter material---�_ :.°` Total length_-_ -C-f---------�-.--�---------- g, <br /> � . <br /> 'Se ge it:� r Qistance to neat we Q._ __Distance from foundation___..___ ___ <br /> ..___.Distance to nearest lot line... <br /> 'V <br /> Number of pit Y g k---._ Size: Diameter.-- �'. P �. <br /> ---I....Linin material--PSD De th <br /> ..Cesspool: Distance from•nearest well .!� -----------Distance from foundation___ --- ---- Lining material.........._______________------4----- <br /> e� <br /> Size: Diameter- -- ---- - ---..Depth-------- ---------------- --------------Liquid Capacity gals 1 <br /> t;. <br /> ,Privy. Distance from nearest welt-----__-------__-----_----------------------Distance from nearest building------.--.._-______.__________-_-_..... <br /> ❑ Distance to nearest lot line ------------ -------------------------------------------------------- -------- ---------------------------- <br /> Y 6 <br /> Remodeling and/or repairing (describe):---._.._ l <br /> s <br /> - ------- <br /> ----------------------------------------- <br /> ------- ------ <br /> :: z ' - .-> <br /> --------------------- -,� i- --- ---------- D G: ? --------------------------------- ---------------------------- -------------- ---- <br /> I hereby certify that I have prepared this ap tcation and that•the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) /f6 0 �f / c•'`phe:_ ?2 ---- ell(—P - r Contractor) <br /> r <br /> By: -- -------- <br /> ---- = (Title)---------- ---------- ---- <br /> (Plot plan, showing size of lot, location of system-in relation to, ells, buildings, c., can be placed an reverse side). <br /> F FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._ ------ DATE. __ _7'-6__P---------------------- ---- <br /> REVIEWEDBY-----------------------------------------:­ ......... -- ----------------- ---- ------------------------------------------- DATE----------- -----------------------•----------------------- <br /> BUILDING PERMIT ISSUED-------- -- ------ - -------------- ------------------------------------------------------------------- DATE--------- ------------------------ <br /> Alterationsand/or recommendations:----------------- -------- -------- - -- -------- ------------ ------ ---------------------- ---------------------------------------------­---------------- <br /> --I <br /> ---........ - ------ --- --- --- - ---- -- - <br /> FINAL INSPECTION BY:. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t <br /> 1601 E.Haxelton 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 />