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FOR OFFICE USE: <br /> - —�. <br /> ---`------------------------- <br /> /_I�__1_ �_EY APPLICATION FOR SANITATION PERMIT Permit No. ..� ��_f._ <br />• ------------------------------------- --- ------- ------- (Complete in Duplicate) Date Issued -----rl_�_��G- - <br /> --------------------------___.___..__.____________ ___ This Permit Expires 1 Year From 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. <br /> JOB ADDRESS AN OCATIC-_ <br /> rL I .� --------------------------------------------------------------------- <br /> Owner's Name - -4. - -------- ------------------- ------------- Phone-.------ --------------------------- <br /> Address........... <br /> - ---------- 13-5- -- <br /> Contractors Name----- 'l�Aparfment <br /> - • � �---------------- --*� ---`- •----------------------- Phone----------------------------------- <br /> __ <br /> will serve: -Residence House Commercial❑ ❑ Trailer. Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __j---- Number of bedrooms __ j__ Number of baths 1_____-Lot.,size ----61_e_.__ ------44' _a__________________ <br /> Water Supply: Public system ❑ Community system E:]', Private E9---Bepfh to Water Table 4_7ft. <br /> Character of soil to a dept6._of 3,fee :_Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe zir pan ❑ <br /> Previous Application Made: (If yes,date.- --------) No 2/w Construction: Yes ❑ No �HA/VA: Yes ❑ No Z __, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: _ -/Distance from nearest well_________________Distance from foundation------------------- Material........-------.__.__-__.._____._..___________- <br /> � <br /> /) / J /J /�u 'a- of compartments Size Liquid depth - Capacity a <br /> �isp/losal Field: istance from nearest well_________________Distance fr& foundation________________._.Distance to nearest tat line_________,____. <br /> (�J ��/ mber of lines--------------------- ---------Length of each line------------_------------.----Width of french--------------------------------- <br /> e of filter material y �,--- -----Depth of filter material__________ __.__._Total length------------- ---________________________ <br /> dui Number of its_ __. _ ,� LI mD}Distance�Pa <br /> found5iz �D`p'` Distance to nearest lot line__D stance to nearest (____ _ _❑ p 9k ter s� Depth_- � i� <br /> Cesspool: Distance from nearest well_________________Distance from foundation___._.____._._......Lining material-__.___-------__-.-._____________..__. f <br /> - <br /> ❑ Size: Diameter-- -------- -- -----------Dept h----------------------------------------------------Liquid Capacity_---------------------------gals. � <br /> Privy:" Distance from nearest Well-------------------------------____----------,__Distance from nearest build'€ng------_--------------------------.______- G <br /> ❑ Distance to nearest lot line__ _____ <br /> -----------­----------- ---------------------------------- <br /> Remodeling and/or repairing describe�__ .- ------ <br /> r <br /> Ir <br /> -- -- `' .r <br /> I <br /> ------------------------------ ----------------------- -------- ---------------- <br /> ---------------------- -----------"---- ------ ----------_----------------------------------------------------------------------------------------------------------------------------------------- ---- ---- <br /> I hereby certify.that I have prepare-•dT"tlriis a`�Ippp ication and♦Wait the work wiI Medone in accordance with San Joaquin County <br /> ordinances, State laws, and rµl and regulations of the San Joaquin Local Health District. <br /> �L � <br /> (Signed)-------•-/-/(7/0------- ��� fL�. .__------ -------- (Owner and/or Contractor) <br /> gY: ~ �7 � � ----------------------------------------------- <br /> (Plot <br /> - ITitIe�Cl� --------------- ---- -------------- <br /> ----------- <br /> (Plot plan, showing si lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> r <br /> ' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__. _ .._._._-- = DATE �2-`-- ------------- - <br /> REVIEWEDBY---------------------------- ------------ ,� - -- ------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED------------- ----'------------------ ------- -------------------------------•- ---------------_,-. DATE-------------------------- <br /> Alterations and/or recommendations:__..-J.l_._f. -�_ -_/ -_' �-'��_Z -_— = Com',/____ ^ <br /> / -71= _ -- --`--------- - --------- ----- -- ----------------------------- ----- l <br /> r .c^ <br /> ---.___ a-� - S--i,`__ �.P_�•-c.--,-,�j= c. c_C <br /> �c,�l.•'\ _.._�__-- ---- 4 --- v-:-C��" /j•L} - - - - ------------------------------ <br /> ------------------------- <br /> 1 <br /> .rte ---------------- - ---- _ ._---------- - - - ------------------ _ / <br /> � !y y <br /> y;Gi -l C <br /> rNJOAQUIN <br /> ------ Li---''1�- Date-------- <br /> FINAL INSPECTION BY:.. _�._�._�--------• --------- - !- - - - --------�---------------- --- --- <br /> LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelforl Av4, 3dk Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> f.P.CO. J <br />