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FOR OFFICE USE: T ' <br /> .-------------....... ........_.......... <br /> APPLICATION'FOR SANITATION PERMIT Permit No. <br /> ................................I...................... (Complefe-in Duplicate) <br /> Date Issued <br /> ......... This Permit Expires 1 Year From Date Issued.—IMP .y�:_ .. .1 <br /> Application is hereby made to the SansJoequin Local Health District-for a permit to construct and install+he work herein described. . <br /> This application is made in compliance.,with County Ordinance No. 549. �nJ : 1/t3-2e0 (y z <br /> 1.?Seto , r_�r pfear°ac,s- �� 1 <br /> JOB ADDRESS AND(LOC�A71t0�N....rE..M�.I�..r.)..�/.y...I/a f�r�-�y��I�Nw�r9/Y�.(-P.SFP., �si�t...s�I.A�'_.c!?t....`... ,q s5rd1�t <br /> Owners Name.._.---.1ry4r!C.P.1:-s+/`........• .'°`d`.- .gid lf...� .C�.�#e .. ......,t..l..._.... --......................... Phone"' ". xF�..k+�-{ <br /> Address.............. L...� .......-.e?l J .. �j .} •r��1'a(7�£rlt ..................`_-............/....... <br /> Contractor's Name..._.......P./� -A-A�..S.C'L-....... F- .- l a e�A.......Jmn........... ............ Phone.�.6hV6 e�7 <br /> Installation will serve: Residence ❑ !Apartment House ❑ Commercial ❑ Trailer Court ❑k Motel ❑ Other ❑ <br /> r Number of living unitr. .�._.. Number of bedrooms 3... Number of'baths�...E Lot sae JA ----Abc%A_ ----•----- <br /> Water Supply: Public system ❑ . Commuunnity'system 0Private `Depth to Wafer Table73."ft <br /> Character of soil to a depth of 3 feet• Sand ❑ Gravel El Sandy Loam C] Clay Loam Pe Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date........ .....) No ❑ New Construction: Yes ❑ No ❑ ( FHA/VA: Yes❑ No❑ �l <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:✓-�} t. d <br /> (No septic tank or cesspool permi#ed if pub�liiccr rsswar is available within 200 feet.) <br /> Sept Tank: Distance from neatest well j..2,?.....Distance from foundationlb......:_Material <br /> No. of compartments----._........�....�..y.. Size..._....-............_...`LiquAidiyd�ep/---i.......... .:.... Capacity. --_---+..`--- , <br /> 41" <br /> Disposal Field: Distance from nearest wpe[1111 SL....Distance from found/at�ion.. -.:....Distance to nearest lot line.Ar.. <br /> Number of lines.".. ##. ...-..---.7. .Length of each line:✓ _....' .Width of trencfi..a'.�W!...t . ...... <br /> Typefof filter materiel..- 4wd ._Depth of filter material.... ..t..�..--.Tc6l length._/..�A'�.:.b.e..�` E.. <br /> Seepage Pit: DistSlSce to nearesf wetl.' rel -.-..--Distanc from"founde'fion ........::distance to nearest lot line.--1 _e... <br /> ANumber of pits-,Z.--..........Lining material. Size: Dia efer.... tl......Depth..- �'4' .............. <br /> s <br /> Cesspool: Distance from nearest well.................Distance from foundation...............-..Lining material...................................... <br /> •• ❑ Size: Diameter... !........... ............._.Depth....................................?.5Z9. ..Liquid Capacity........___..._-...gals. <br /> Privy: Distance from nearest well................................................Distance,fr`'om•r,earees1tibuilding�..:._.... .......--............... <br /> . <br /> ❑ Distance to nearest lot line-. -............................... -.-... -- '-.—# .•...... 1 - <br /> t {� t ' <br /> Remodeling and/or repairing (describe):-__-S..-_/-.,.T.:. CAJ._.... .... .....j ------- <br /> �a .... :..,... <br /> !�j �..... <br /> ....-............................ ...... <br /> _ .. v <br /> ......... . ..... :.................... ............................... ... .. .... _.. ..-.................?......... �... .-...3.. ......-� <br /> I hereby e prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State I ws, andr+,les and regulations of the San JoaquinpLoscall Health Di3tr'Ict. <br /> [Signed}.................... .........L'.1'.-...�d-- --- �A�.!.....--... -....- .L!J .........6----------`.._t!±.....((Owl�narAand/or Contractor) <br /> BY -..:....!._?. + !... .r�-. ' ...... .Title...... Cd.§..nsl� _......... <br /> (Plot plan, showing'size of lot, location of system in relafion o wells, buildings, etc., can be place n reverse side). <br /> k� <br /> FOR DEPARTMENT USE ONLY + <br /> APPLICATION ACCEPTED BY .. .-. - --- ----- DATE-F-7--G..7------------------------------ <br /> REVIEWEDBY....................................._..._.......---......--- -- ------- --.._.......................z...,DATE.................._--...--•-------­1............... <br /> BUILDINGPERMIT ISSUED..._.....,............. ..-...............................------ - --....._.........!-. DATE................... --------------------;r............ <br /> Alterationsand/or recommendetienst................`.---'-'--- ............_;_................_....-..........A._...........-----.......-..___..---............... ............. <br /> -...-----............. ...... :..._............. _-....--.........-............. .......................................................................................... - <br /> ....----._......................................_...._......................................- .................-..............:......_.................._ ............................................ <br /> ........................................................_.....----........._...............----- ----................................,.---....--------------........-------------------................ <br /> .......................................----p.............................................._... .......... ....-•---.......?.-............................ ...............' .......... <br /> ...... <br /> FINAL INSPECTION BY:. .... J..•�/1.,.......................... Date.................. c...Z.._...................... <br /> ...... <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 !.Marslren Ave. 300 Waaf Oak Street 134 Sycamvn Street 205 Wast 9th anor <br /> Stockton,Celifoinie Lodi,California Manteca,ColifertMe Tracy,California <br /> E.X.92M 1.6] V­,.H pre,` <br /> r <br />