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FOR OFFICE USE: <br /> ;/p 1?3 J/ <br /> - ------- ------------------------- Perm <br /> ------ ------------ --- APPLICATION FOR SANITATION PERMIT it No. <br /> ----------------------------------------------------- - (Complete z---------- (C'0';Mple-fe`ln Duplicate) Date issued <br /> ;This Permit Expires I Year From Date Issued #41"' <br /> Application i.s hereby made to the'San'Joaquin LocAl Health District for a permit to construct and install the work herein described. <br /> This appanon in comAiancgOwl)h Cou rdinance No. 549. <br /> FADDRESS <br /> JO D LOCATION�qo?A__ <br /> Phone------------------------••----•---- <br /> Owner's <br /> ... ------------------------------- <br /> Owner's ------------- --- <br /> ---------------Phone------------------------------------- <br /> Address---- ------------ ------ <br /> --------------------------------- <br /> Contractor's Name_---_ V-a_4--*A <br /> Installation.will serve: -Residence Aparfmont,House.o. Commercial 0 Trailer Court 0 . Motel [] Other 0 <br /> Numbe'r of living units: Number of bedrooms Number f baths _?"' Lot size ----- -------- ------------- <br /> 1' "1 <br /> m 0. Cor�nmunify system El a �bepth to Water_TabV'"___��--- <br /> Priv Private Wafer Supply. Public sYsf; A d� <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam [I Clay Loam 0 Clay. 0❑,�,Aclobe E] Herpan <br /> Previous Application Made- (if ye.s,date--------------- ----) No 0 New Constructio'n: Yes n,iNo 0 -,FHA/VA. Yes ❑ Na E] <br /> -TYPE40F-INSTALLATION-AND;SPECIFICATIONS: <br /> 7 <br /> (Na septic tank or cesspool permitted if:ru61ie­s&Wiir_ii��VaiIibI 'i�ithiir 2004.k) <br /> A -------- <br /> Distance from nearest well__.ir------'Distance from founcla�ibn-------1P--- Material---- <br /> Sepfi nk: --- .1 Capacity_/.�!;? <br /> No. of compartment,-----2- ------------ depfh 14-1------------------- sFfl <br /> �Nr . est lot line_ <br /> ----------- <br /> r ----Distance to near <br /> DispO I Field: Distance from nearest well___'-O <br /> I-----Distance from foundafio'n <br /> Length each line ____j -----------Width of trench--. -_/------------- ------- <br /> Number of lines._.______ <br /> ------------- _g-------------------------- <br /> Type of filter material------_5�jZLi- _.Dej��fof filter rr)aterial-----1_q----------Total <br /> Seep e Pit: Distance to nearest weII_.__/_W--- ---.--Distance from foundation----J.A.........Distance to nearest lot lin --- ------ <br /> Depfk_..,�24--------------------- <br /> i Number of pjfs._z:___* Lining material......5_11a-------Size: Diameter.-._.. ------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------------_.Lining material-.-_-.-----_-_-._.--_------_-..--__.----- els. <br /> ---Liquid Capacity------------------------- <br /> 0 Size: Diameter------------ ---------- -------Depth------------------ ------------------------------ <br /> ---------------------------------------- <br /> Privy: Distance from nearest well--------------_-____-- ---------------------------Distance from nearest building. <br /> Distance to nearest lot line------------- -------------------------------------------------------------------------------------------------------------------------------- <br /> ❑ <br /> Remodeling and/or repairing (de cri� ------------- ----- ---------------------------­;;-------------------m--------------------------------------------------------------------- <br /> -----------­----------- ------------------------------------------------------------------------------ --------- ------ <br /> --- ---- - -------I------------ <br /> -------------------------------- --- --- <br /> --------------- I r ---------------------------------------------------------------------------------------------------------------L--------------- <br /> ------------------------I----------------------------------- --- ------- .....I------------ i <br /> & t --------I---------------------------------------------------------------------- -------------------------------------- <br /> ------------ --------------- ----------------------------- <br /> -------------------------------- in County <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> ordinances, Stat s, and rule and regu#l'ons of the San Joaquin Local Health District. <br /> -------------- -and/or Contractor) <br /> ------------------------ ------------------------------------ <br /> ed)-------- V------ <br /> -(Sign, <br /> ------ - <br /> --------------- ................ <br /> -------- ----- ---- ------- -----(Title)---------- ---------- <br /> By:._- ---- --------- ---------- <br /> (Plot plan, showing size.of.lot, location of Wsystem in relat n to wells, buildings, etc., can be placed on reverse side) <br /> FORDEPARTMENT USE ONLY- <br /> . <br /> ---- DATE-Za- o----------- _1---------------------------- <br /> APPLICATION ACCEPTED BY------ --- --------------- ------------------------------------ <br /> REVIEWEDBY----------------------- --------- -------------- ------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------- ------------------- ----------------------------------------------I--------- DA7E--------------------------------------------- ---------- <br /> Alterations and/or recommendations:------ ----------- -- - --------- --------------------------------------------------------------------------------------------------- ----------------- <br /> -------------------------------------------------------------------------- - ---------------- ------- --------------------------------------------------------------------------------- ---------------------------*1------ <br /> --------------------------------------------7-------------------------------------7-----------------------------------------------------------------I-------------11-------------------------------------------------- <br /> _--------------- ---------- <br /> ---------------------------------------- - ------------------------------- ----------------------------- --------- --------------------------------­­_.�--------------- ---------------- <br /> - -------------------------------------------------------- ---------- ----------- ------ <br /> ------------ ---------- <br /> ------------- ------------ ---------- ------------------------------------------ ----------------------------- <br /> o. <br /> - _;-------------- --- ---------------- --------- <br /> t FINAL INSPECTION BY:...../11 ------ Date-- / ' -9 --------- -0-1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street V 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 9 REVISED B-59 2M 3-63 F.P,rD. <br />