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/-=..Z'L-..6-�.._ .._...... APPLICATIO'l FOR SANITATION PERMIT Permit No. <br /> _.._ _..... ... ---_.. ._.... (Complete in Duplicate) 7 <br /> - - ......" - This Permit Expires 1 Year From Date Issued Date Issued <br /> LApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. <br /> Th;s application a made in co m lie ce with County Ordinance No. S49. C A �'. <br /> TH O <br /> JOB ADDRESS AND LOCATr6nt.LOc-.._/'IW./....SCJ-.".--.F.s.0NTA,�E----- LZ........- t?tk:::rQ.--,.._� O.T-N..-. Rr <br /> Owner's Name --_..--...--.-C .._F-....G �y1G. ..�� _......................... .. Phone.................................... <br /> Address-`--------------l. r.E...-.-. .---...`....--U. ,K .................[tIT_H.R0.�-:_:---_....--.-,---------•--------•---._. <br /> Contractor's Name-..M.1-F"....-.. ........................_-. . Phone................................... <br /> P.i..�'-rte►-.�r <br /> Installation will serve: i Residence E&�-Apartment House ❑ Commercial ❑ -Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ....II--- Number,of bedrooms .2—. Number of baths J---- Lot size .....11-3--. --`,'.".Z.g............." <br /> L Water Supply: Public system ❑ Community system ❑ Private ZIDDepth to Water Table /S.fft. <br /> Character of soil to h `d` epth of 3 feet: Send (Gravel E] Sandy Loam ❑ Clay Loam E] Clay C3 Adobe E] Hardpan F]Previous Application f ade: (If yes,date....................) No.iI�I' New Construction: Yes C2��o ❑ FHA/VA: Yes 20"`No ❑ <br /> i. TYPE OF-INSTALLAT ON ANDSRECIEU;A.VQ <br /> (No septic +ank or cesspool permitted if public se5vu�lable within 200 feet.) �1��GAS1' <br /> LSeptic Tank: Distance from nearest well-.-5.0....Distance from foundation.../Q.-..--..Material-... Q- <br /> 59_� No. of compartments.....2................. --.Liquid depth-.,Y/_-j Capacity <br /> Disposal Field: Distance from nearest well....-'x.5.7.-..Distance from foundation.-/-Q......---..Distance to nearest lot linel <br /> F]— Number of lines.......................... ........Length of each line....... Q........-....Width of french........ <br /> 11110 <br /> Tye of filter material---RO.1C.rN. ..Depth of filter material-....1.7 ......-Total length..:..............:........................ — <br /> Seepage Pit: Distance to nearest Jell- --- <br /> . -----"--".--."---Distance from foundation....................Distance to nearest lot line..........._.... <br /> El Number of pits..........:...........Lining material...--.--..-..--.--....Size: Diameter.....-.---.."..---.....Depth..-.--.--....--.........-........ eJ <br /> Cesspool: Distance from nearest well.................Distance from foundation.'....._..........Lining material..................................... <br /> ❑ Size: Diameter....... .................... ........De th_.-.........------ ...--.....-....-. <br /> i� - - .-..Liquid ,Capacity- -- -----•--------..gals. <br /> L .-.......Distance from nearest building................ __XPrivy: Distance from nearest well,...................."....-.-.......--.- <br /> J <br /> ❑ Distance to nearest lot line. ............................................... <br /> ------------.----.-_-^_.--..-..-_`-.-_-.-.------.------...-..__---..--.---_-.-...--_ <br /> ". <br /> L Remodeling and/or repairing (describe): - -- - ..- .-.... - ..........................-•• .................. 7 <br /> c <br /> ---- .... - ...... ` ..... <br /> L ordinances, SI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Jate laws, and rules and regulations of the San Joaquin Local Health District. ' <br /> (Si ned - <br /> g---)----5- .... .•<S._- rn'.i.":�',rfi:i-tet.'.-c.t..i.': N:.-. . (Owner and/or Con+ractor) <br /> t. BY`........-----------'.... <br /> ......... <br /> ......-........:-..-.C..1-:...---c•_ '- !.:r :,�:--_[`'--�_...-.--rr(Tit e�'-�r[..�....---..-.L....--- ....--"._. ......... - <br /> (Plot plan, showing size of [of, location of system in relatio to wells, buildings, etc., ca-1 be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.-......-Tt.IZ1._.. ,_._......................._... ..............._-. DATE-......":.-"�.":-2.3--.� . <br /> REVIEWEDBY-,--------------------- ---""_-._.....-...._....._ - r............. --- --- .._ ......... ... DATE-- _----.... <br /> BUILDINGPERMIT ISSUED......"-.. - ...............................................- ------------..-"...__......... DATE......_ .......-.-.."-.._-.......... -- - - <br /> Alterations and/or recommendations:,........................... .. ............. <br /> _ ...-..-...._.............. .......- ..... --- ----..................... ..._._.�-.................:...-_... -- ..._-...............--- - ...... ----------- ......................... <br /> _."....._.-...._."...-........_....._..-....._...-..._._-.. _ _...._... . ._. ........"................. -----............. <br /> ..---------- _.-.-.....-......-.... ......... <br /> _.. ._... _._.-.... _."..... _ <br /> ................ ............................................................. ------------ _................- ........ <br /> __. _ ..__...._ ._.... _ .. .. ................._...".. . ......__...._ ..._._.....--..-.__..._._ ..._...................... ................."..... ...... . .............-...._.... <br /> FINAL INSPECTION BYr.:-..�,. ." .. C..�.'...l ?4.. .��' -.� Date_....�..'_v�._7`-6..,�.-_............-..............- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT . <br /> 1601 E.Hoadt.n Av.. 700 W.tt Oak Street 124 Symme,e S1r..1 205 West 91h Slre.t <br /> Smckten,Cofifernia Led],California Monteco,C.Iifornia <br /> Tro<Y, Cali lornle <br />