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FOR OFFICE USE: <br />--- ------------------------ ----- -------------------- <br /> ."'.. <br /> -a _--..- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ___ (Complete-in Duplicate) , 1 <br />.-" .-"-----_ - --."". _... . -. ._-__-._-. This Permit Expires 1 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`wifh County Ordinance No. 549. Sc,04-0Ai ,I <br /> JOB ADDRESS AND OCATIO - �Ir��­4 -1: ---- .��'=�-� --�"�'-''-"-�----,�--`-''�------ � -� -----E --------��-D <br /> Owner's Name A1W6iVD N-------Ml-I'1��_L1.� �--- --- --------------------- --- ------ Phone-----""•---------------------------- <br /> Address--.._-- <br /> Contractor's --- ---------------- -- ---- --------//.- ----........ Phone <br /> Installation will serve: Residence ErlApartment'House Commercial ❑ Trailer Court E] Motel ❑ Other [I--I- <br /> Number of living units: ---- Number of bedroom_Y__,'14umber of baths-_- Lot size -_fICR.EI9-0:�----.------_--__-_---.--._ <br /> Wafer Supply: Public system ❑ Community system ❑ Private Depth to Wafer Tablev..,-.?- ft <br /> 04 <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam P—Clay Loam [:❑ Clay ❑ Adobe ❑ Hardpan ❑ n <br /> Previous Application Made: (If yes,date------------------- ) No [ New Construction: Yes 0No ❑ FHA/VA:;Yes �No ❑ `J <br /> TYPE OF_INSTALLATIO_N A_ND'P� ECIFCCATIONS: - <br /> No <br /> septic #ank or cesspool permiffed If public sewer is available within 200 feet.) r• <br /> Septic Ta Distance from nearest well---_,]v--Distance from foundation--.-� Mated I -COII.C__ <br /> No. of compartment`s- - "---------- - -- -fir -O �r quid depth --.3 .. - CapacitY AQ ) <br /> Size_ /l li/-14-- ----Li <br /> Disposal Field: Distance from nearest well._5 ----Distance from foundation---1°©._.......Distance to nearest_lpt line---- <br /> �~ ��^ r f. <br /> Numberr of.lines...(__,fes:,; __,_____Length_of..each .ine,--,- - - __.-.-___- -_.-..:Width of trench <br /> .--.--<-- ------------------ / I <br /> Type 'of filter material-- ------Depth of filter material --- <br /> Seepage <br /> _1 -J�..-.----.Total4 length----..�___ <br /> Seepage'Pit: ------ <br /> Numb' of, nts rest well',10.0__a---l.- ameter-- Distan to nearest lot line-- �~--.- , <br /> -.__-Linin materia L_ O-C -- -_. Size. p�Q <br /> - , Distance�fr`om�£ounc3ation-�= Sg <br /> p I 9 X.-` Depth -t ` <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- -.Lining material---_------------------------------------ <br /> 0 <br /> --..-------------- -.❑ Size: Diameter- ------------- ----- - ----- Depth------- ------- -----------------Liquid CapacitY.--------------------------gals- <br /> Privy: . ',' Distance from nearest ------------------ "------------------"Distance from nearest building_.--_"___.._____-------------- <br /> ❑ -------- -- ----------------------- --- -- - <br /> Distance to nearest lot line } <br /> Remodeling and/or}repairing (descr be): - -------------------------------------------- -----------------:---------------- --------------------------------------"-------- <br /> ' ---------------- <br /> - <br /> t _ru�='1 i <br /> f _ 1 <br /> herebycertify'thafl.have .this,a .plication-and.+hat the_w.or:k.will-be.Aone-in.accordance,wt San,.Joa Joaquin Count r <br /> Y - P I q Y `a <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ] i <br /> �,n Ic0 O�'I ; <br /> (Signed t'fCl -------------------------- ---- -------- -------•--------------------- ..1 { caner!and/or Contractor) <br /> I <br /> By - = = -----------I--------- { } <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed_on reverse side). <br /> - ; <br /> OR-,D.EPARTMENT-USE-ONLY.. .- .- --1 ` <br /> APPLICATION ACCEPTED BY------ �.,_ -O----------------------�----- ------ ---------- -------------- DATE------ 1Z 2 <br /> y� - <br /> REVIEWED BY--------# s -- - DATE <br /> BUILDING PERMIT ISSUED.----- --------- - ---------------------.. DATE---- -----`- ---- ---------------- -- <br /> I <br /> r <br /> Altera#ions-and/or recommendations:-- ---1..---------------•- :.-.-.-.-"... .. ------- ------ . <br /> �.. <br /> 2 <br /> ti t. � " <br /> j <br /> ---------- ------ --------------------- <br /> 'FINAL INSPECTION BY:.. - V ----- Date-------y---�`�-- ....... --------------------------- ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1,601 E.Hazelton Ave. 300 West Ook Street 124 Sycamore Street `j05 West 9th Street] i <br /> 5tvckton,California Lodi, California Manteca,California (Tracy California) <br /> E.H.9 2M 1-67°,`-Vanguard Press <br /> aI' ® <br />