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f tvn <br /> --------------. <br /> ......... ....................................... APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> ......... ------- (Complete in Duplicate) <br /> This Permit Expires l Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per it o-c struct a stall the w rk herein described. <br /> This plication is made in compliance with County Ordinance No. 549-�, �' a rti.1 ys � �+, ' a.„! <br /> ��3pz3 F.. st:',t5c A4 r <br /> JOB"ADDRESS aND LOCATION-_ ' . 3 ��07— 'Q?o <br /> Owner's Nome..' � L`� -------------------•--- -- -------.---_ .... ....1..._--------- <br /> ----- - J✓.. .•�.._(----.... ._.... �. �)Phene.J3..��-.Y��1------- <br /> res � .... _... <br /> -- `'�J ` ................i...... J ....._-..................... <br /> —---------- - ... <br /> Contractors 4`u' :.__........ Phone r- -� <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [:1 Other ❑ <br /> 1 Number of living units: J._._ Number of bedrooms :Z-- Number of baths ...J... Lot size _ I sft <br /> Water Supply: Public system C1 Community system E] Private �epth to Water Table '7-._ . <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel El San y Loam❑ Clay Loam ❑ Clay C] Adobe Hardpan C]Previous Application Made: (If.yes,date_........... .... .} No ew Construction: Yes �o ❑ FHA/VA: Yes ❑ No <br /> TYPE'OF INSTALLATION AND SPECIFICATIONS: <br /> - (No septic-tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T n Distance from nearest well.................Distance from foundation.....--.............Material................................................ <br /> �.> No. of compartments.......................-Size.....—------------ ..Liquid depth.................. Capacity.___ . <br /> Disposal Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line_•-_. <br /> Number of lines-............................... Length of each line..............................Width of trench-.__-......_--................. <br /> Type of filter material.........................Depth of filter material.....................__Total length............... <br /> -_.».._ Zi <br /> ..._ __....__ <br /> Seepage Pit: Distance to nearest well.j.6':O-'.J_...._Distance fr m fpun�dation---ID..--.-.__-.Distance to nearest lo+ ine._.......!_.._. <br /> Number of .........Lining material.....tf�f-•e:�.Size: Diameter.... �'--- --__Depth...? <br /> Cesspool: Distance from nearest weft... ...___..._Distance from foundation . .............Lining material..........._........................ Ir.Ft, <br /> 0 Size: Diameter......----•............. ....-- --.Depth --------•-- ----._..•------...........--------.Liquid Capacity................._........gals. <br /> Privy.1 Distance from nearest well.................................................Distance from nearest building........._........................... � <br /> ❑ Distance to nearest lot line--------..................................._ ..................----___--.._-.----- .---...------------------..-..------------• Sit <br /> Rem eiing and/or repairing (describ©):.......�t'�.'� .7 tX ttJ- .i 'rl-'-.. -J .__-.-T._'.`ec--- . -.------- •-e' �'....Q,----... <br /> .......... _._.................. ....--------...-•----------............—•--------•--- --------- a..... <br /> --- <br /> ....--........__ ..:-____........................-----__.-...-•--•-•--•-•......•......._ <br /> A <br /> Vhereby Certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 <br /> ordine State laws, and rules and ulation of the San Joaquin Local Health District. <br /> ------- (d--------------- c Owner and/or Contractor <br /> (Signed ,, 1 .. ------.•_--.._-.__r.......---- •----•...............//� ( J r <br /> 1By:---•-------fin ------ -• a"" _ -------- <br /> n <br /> •-------------- �---...... <br /> ( °-— <br /> (Plot plan, showing size o lot, location of system in relation to walk, buildings, eta., can be placed on rover s'ae. laln, <br /> a <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. Tt_R-_D'.-•------- •------------------------•----- DATE- ...:Lr�..`43......................... <br /> REVIEWEDBY....----- - _. .. ......--....._....-...........--............................—_......---------- DATE_-----•---»--- <br /> BUILDINGPERMIT ISSUED..._................ ......................................_-•.----------•------------- .. .._ DA•TE-•----.----.----..._.-_.-------•---. -.----- _----._ <br /> Alterations and/or recommendations:_,.:4.lZ.��ct3.............Ll/-9_!._---JRJ � -'•---•-- '. .........----------------•----•----••-----•--••-------._... <br /> ..........°........................•----•---.....__....----�_.=_1. .-b3_......PM_ P�T._....�.; P..r ...... ... E .........-•--------..._------. <br /> ii <br /> .r•,a_Q1y St ab.- -�-,R.�-0---_--• t <br /> ».................. - - ----- -.-... <br /> NntlEC-2 4_Q N... X i S.7!.14 .....U.nl .....PtT....P1�/4 R'.0,� ......... <br /> A L <br /> Date.. ... I3. ......... <br /> FINAL INSPECT40N BY: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 730 Seu16 American Street 300 West n /� v S+'�'� wn■.u__.o.�••--• <br />