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rUK UI-rice USE: -- - <br /> --------------------------,I-----:-------- ------- <br /> -------------" ------------------------------ APPLICATION FOR SANITATION. PERMIT Permit No. <br /> ----------- 5 ------ {Complete ii Duplicate} f/- <br /> F .A4 <br /> i---------=--------------fix'--'---- �` ,This Permit Ex ires 1 Year. From Date Issued �` Date Issued --------......... . <br /> Application is hereby made'to the San Joaquin <br /> ocal Healfh District for a permit to construct and install the work herein described <br /> This application is made.in compliance with Counfy�Ordinance No. 549. <br /> 01 <br /> JOB ADDRESS AND LOCATION---...Y9.1k4��!� ._...Rv------- ,L�� ®F G*F�� <br /> Owner's Name--__ <br /> r :.: Yn(. -R-=--- --- ,_ Phone, <br /> - ----•--••-•--------------•--------- <br /> Address-------- -1�`�-----------UP4—nab.-:-------RD.-----...:.Rf:�,IwjaQb_ a T�-----------•--- <br /> Contractor's Name.-•-•--_1 --•------------_-- ------------••----- Ph o -- - ------ <br /> {, Installation hill serve:, 'Re`sidence E] Apartment House ❑ Commercial ❑ "Trailer Court ❑ Motel,❑';, Other RM S <br /> N,ijm6er of living units: ___ --_ Number of bedrooms ._ -- Number oflbaths __/_- Lot size ._ <br /> Water Supply: Public system ❑ Comrnunity.system Private Depth to Water Table <br /> Clieracter of soil to a depth of 3 feet: Sand 8Gravef ❑ Sa dy Loam' Clay Loam ❑ -Clay ❑ Adobe❑.. Hardpan ❑ <br /> eyt ..,. <br /> j "ous'Application Made: (If yes,date--._...... .......:} No' fT' <br /> Fr New Construction;; Yes W"No ❑ FHA/VA- Yesl'❑ No 1� <br /> } TY <br /> �- _-PE 'OF-INSTALLATION-AND SPECIFICATIONS: <br /> f-- <br /> {No septic:#ank or cesspool permitted-if public sewer is availabthin 200 feet.) <br /> Sepank: 1' Distance from neares# well___5 ------Distance from foundation__. - <br /> �..k <br /> 1t� M real_ e-DIN <br /> No. of com artments ' ='_ <br /> Capacity_ <br /> p ~ Size _ _ _s? Liquid depth <br /> i <br /> l Dispgs Field: Distance from nearest wellt_s5 -,-_-Distance from foundation __ <br /> -------- <br /> ___'' Distance to nearest lot A e.__ -: <br /> Number of lines x ` / .- <br /> •' 1 -----------------------Length of each line-- --- AO-- ------------Width of renchY I , <br /> Type of filter mat nalt�___�1 _--Depth of filter materia_-----�_- .-__.Total length____________________ _ ----_----•- <br /> a 'r <br /> Seepage Pit: ., Distance to nearest well---------------------rDistance from fooundatio _--.Distance to nearest lot line_-_ <br /> ❑ Number of its_ ---- Linin material--- --------- - ameter .Depth = -=-_------------- <br /> Cesspool: <br /> rDistance from foundation. <br /> p g Size Di <br /> Distance from nearest we€f_______________� <br /> i --.Lining mafi3tial <br /> ❑ Size. Diameter._ -- aDe h r�r # r�. - <br /> -"_--- . ' D stance f = L+Liquid Ca acs <br /> p - I p p tY gals. <br /> Privy: Distance from nearest well; -------- � �,rom nearest building! <br /> ❑ . <br /> " �yDistance to nearest"lot line------------• F -----•-------- ••---- ------- <br /> d . <br /> Remodeling and/or repairr g (describe): ------------------------------------------------- <br /> ­ <br /> ;----------- ------------------ �----------------- ---------------- -- <br />( . _4e, <br /> r ------- -----------•--------- ------------------------ --•------ ---•---------------••---------------------------- <br /> - -----------------•-------•---------•---- - -_ , ------------- -------- - <br /> ------------- <br />+ I herebycerfif that I'have re ared this application and that the work will be done in accordance'with San Joaquin County <br /> ordinances, State laws and rules and regulations of the Paan Joaquin Local'Health District <br /> {Owner and/or Contractor) <br /> B <br /> = p .- _- --- - f <br /> y <br /> I (Plot plan, showing size of lot, location of.s`stem in relation to wells, buildings, etc., can beiplaced on reverse side). . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ' DATE �. , <br /> ----------------------------- -- <br /> R�PVIEWED BY- --- ----- ;------•- •-------------;--------------- `-----•---------------- -' DATE ---•-• ----••----•-•-- <br /> BUILDING PERMIT 155UED------•••----------- ------------------•-------- ------ ------ PATE----------------------- <br /> . Alterations and/or recolnmendattons:_.-_--..___.___--._- ------._:_ - <br /> ------------------ ---------------------------------•--•-----••-----------•- _ ---- <br /> -----•------------ ` <br /> ------------------- • ------- ------------------ --- <br /> FINAL INSP '?% -- - ----- -- Date------. <br /> \jVMjSut1h <br /> -..-_ - W <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 13American Street 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California <br /> 1Manteca,California Tracy,California J <br /> E9-9 REVISE-59 F,P,00.2M 6.60 _ .'1 <br />