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FOR OFFICE USE: <br /> ---------- --- ------ -------------------------- Permit No. <br /> AP CATION FOR SANITATION PERMJT)_- <br /> ------------------ --------- <br /> -----------......... <br /> --------------------------------------- -- -------- (Complete in Duplicate) Date issued <br /> Issued <br /> 21- ................. . ... This Permit Expires I Year From Date <br /> Application is hereby made to the San Joaquin Local Health' District for a permit to construct and install the work herein dcl-libed. <br /> I <br /> This application is made in com" liance with County Ordinance No. 549. <br /> V . k.4 15 _Aj-- ---- <br /> -P ---Tc <br /> JOB "ADDRESS AND LOCATIO -- ----ow------6-F-------- <br /> �l D GV_KPhone.Owner's ----------------------------------- <br /> Name--------- - ----------- ---------------------------- <br /> fjF_ --------------------------------------------------------------- <br /> Addre'ss-----------_------8 Tom_ --------8V��------.5.77------------RI-P _N------------------- -----------_------------ <br /> Phone......... <br /> Contractor's Name--------__0_WN_F__P----------------------------I------------------------ -----------------------------------­--- <br /> �j Commercial E] Trailer -e=t FL,?- Motel El Other 0 <br /> Installation will serve: Residence n Apartment House 0 <br /> li Number of living Number of bedroomsb <br /> units: ._____ I---- Number of baths I... Lot size ___,6_CREA_64�7-----------------­-- <br /> Water Supply: Public system El Community system [] Private t!rDepth to Water Table /3 ft. <br /> Character of soil to a depth of,3 feet: Sand 0 Gravel F1 Sandy Loam Rr-!CI.ay Lo.am C] Clay E] A.doba El Hardpan El <br /> Previous Application Made: (If yes,date........_-------- No 55�New Construction: Yes g?-15o E] FHA/VA; Yes ❑ Nof;! <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> i (No septic tank or cesspool permitted if.-public.sewer is available within 200 feet.)- <br /> % <br /> Distance f m nea Distance from foundailon----/0----------M ­---------------- <br /> .. ....:)_.- - -------? <br /> Septic Tank: resi well-. it <br /> No. of c Size": x: Liquid z—------Capacity___ ..... <br /> - ----------- L id clep�k----9�� <br /> compartments_...._om <br /> 50.. :Disfaince from foundation-14)--- Distance to nearest lot line---I <br /> Distance 11 Pa nea weU--.- ------- <br /> Disposal Field- from rest Width of trench-_.___ ------------- <br /> Number of lines------------/j- ---------------Length of. each line______.__- I........ <br /> filter material.....1 ____-Total length--------- <br /> Type of filter mat Dept_!�f-.� <br /> �1 I sf well---- ---------Distance from foundation-------------------rDisfance to nearest lot line-_-_"--___._.-___ <br /> See�aqe Pit: Distance to nearest --------- <br /> ------------------ <br /> ❑ Number of pits.-- . Lining material—_..... ...... <br /> Diameter - ------------- Depth--------- <br /> Cesspool: Distance from nearest well_ ___.__"_....Distancefrom foundation----- .. ..........lining material"""_--._-__----"-.---__...---- <br /> -------Depth...... -----I- --------------Liquid Capacity----------------------------gals. <br /> 0 Size: --------- -------------------- <br /> Privy: Distance from nearest wO------------- -------------------a....I............Disfance from nearest building------------------------------------------ <br /> ------- ------------ ---------------------------- ---I Distance to nearest lot line-...- ...------------ ----- ------------------- ---------------------- 7 <br /> ❑ <br /> ---------------- <br /> Remocl6ng and/or rapairing [describe)---- -------- ------------------ ------------------------------------------------------------------------------------------------------ <br /> EI <br /> -----------_-----_------ ---------------- ----- -- <br /> ---------- ------------ ------------------------------------------------- <br /> ------------------------------------------------------------------------------------------- - - ------------------ <br /> -------------------- <br /> -----------------­-------- ----- ----------- ------------------------- <br /> -------------- --------------- ----- ------------------------------------------------ <br /> -------------------------------I------- ------- --------- <br /> --------­--- ----------------------------------------------------------------- <br /> -------------------- - -------------- -------- C <br /> 7; 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin our <br /> ordinances, S to laws, d rules and rejguioZns,:afthe San Joaquin Local Health District. <br /> ...._(Owner and/or Contractor) <br /> (Siq'ned)-------AW...... ---- - -- ---------- -------------- " - <br /> ------------ -----(Title)------ ------------ ---------- ------------ ------------- <br /> By--------------------­----------------------- ---------- ------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> --------------- <br /> APPLICATION ACCEPTED By------ -------- ----------- ----------------------------------------------- DATE------- ---------- <br /> .1 . DATE_ <br /> ------------------------------------------------------- <br /> REVIEWEDBY-------------------------- -----------___---------------------- ......... --------------- DATE------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED-11 ------------------------------------------------------- --- -------- <br /> Alterations and/or recommendations:.--------- ------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------- ­-- -------ii 11......_.............. ---------- --- --------------------------------I-----------------------------------I------------------------------------------------------------------- <br /> -------------------------------------------------- <br /> ........... ...... -------------- -------------------------------------- ------- ------- ---------------------- <br /> ...................... -------- ----I ------------- -----_---------- <br /> J1, ­ ­ - - -------------------- ------ ........... -----------­------------ <br /> ------------ ---------------------------------- ----------- ------- <br /> ..... .... .. . --------------------------------- ........ ------ .............. ... .................. ------------------ <br /> ...... ----- --------- - -- <br /> ADate....... .... .... -------------------------- <br /> FIN�,L INSPtc��_04. V/ <br /> W N <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelldh A". 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> Lodi,California mantecOr California Tracy,California <br /> Stockton,California <br /> F <br />