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FORUrt-K-1: Uoc: <br /> APP :ATION FOR SANITATION PERMI— Permit No. k.r<.9A.a <br /> (Complete in Duplicaf ?ct <br /> Date Issued <br /> ------ ------ <br /> ------------------------- This Permit Expires 1 Year Fro ate su <br /> Application is hereby made to the San Joaquin Local Health District for a p t sndstall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 1, . LFTIIr, . <br /> JOB ADDRESS AND LO ATION. .......e SQ--- t- �ee" -------­------------ - ``-//- ��,,pp <br /> Owner's Name--_---_-_-._... Phone._7i-�_-�7..--_ -- <br /> Address....................J--............. <br /> 'ti'" --------------------- ------------------ -- - -- -- <br /> Contractor's Name..-2R5 f - E- T'L...... <br /> qZ---- Phone... --------•----- <br /> DFPJAI R <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -------- Number of bedrooms ........ Number of baths ------- Lot size .-_.-.�D-. Y ------------------ ----- <br /> Water Supply: Public system ❑ Community system ❑ Private J( Depth to Water Tal?les3.Q. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe x Hardpan (� <br /> Previous Application Made: (if yes,date_-------------- ---) No ❑ New Construction: Yes ❑ NoX 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 /> s <br /> Septic Tank: Distance from nearest wellAve..40_.__Distance from foundation_-.,/O.....__.Material-.-_-- - ---.__---------- ----- <br /> . t <br /> ❑ No of compartments-- ._"cam.'-. .---Size-- _Q-- �•--'.........rL'Liquid de th=-a� - Ca a �.- \ <br /> KI P P qtY - <br /> AF �. �. <br /> Disposal Field: Distance from nearest welL.jO.Q_.Distance from foundafion..._.��0-------Distance to nearest lot line-- <br /> ❑ Number of lines_.--_-._- ..___..--.._'Length of each line---:. '&---------------Width of trench--------- Y.� - ---------- <br /> Type of filter materlaL..R --.---Depth o6 filter material.- --- /-? -----.Total length...............IQ.Q____.._.._.._... <br /> Seepage Pit: Distance to nearest well..,./W--------Distance-from foundation --------Distance to nearest lot line-_-_-...._.-_.. <br /> Number of pits_. 2--._.__-_,Lining materiaLROC&...._.Size: Diameter.2-?(10.....Depth.:----tyy l-_'_-.----_.------ <br /> Cesspool: Distance from nearest,well--.._...---_..:_Distance from foundation....__.._.._.....Lining material--..--.._..__.._-_.._.-_--. <br /> ❑ Size: Diameter.--.... ---- ---------'-Depth------------------ ----------------------.-Liquid Capacity......................._-...gals. <br /> Privy: Dista-nce from nearest well_..---._.....-..._.--..-._.-----------------Distance from nearest building------------------------------------------ <br /> - _ <br /> ❑ Distance to nearest lot line.......------- - ..............------- -- -- -------.....----------'----- ---------- - -------- ----- -------- ---- ---- <br /> ----- <br /> Remodelin and/or repairing (describe):.- --------- ---- - ---.------._.VL '---.. .-- ........Z2 ---- /�`' - '- ...... - <br /> -._Ila----- T(R.s Mix- -Wn-�-rN------(S-E#aGE... ..ov,�4NQ.ul `'YSrE'�t. ?' . -�3 <br /> ...0SE! -------FOR------t.-V 15 74M..._i TER.....Exam.......5TEA-M...... -`---------- - ---------------------------..._.._-- <br /> ----------- ... ----------------------- ------------_--------------...------....------------------------------------ ------------------ ----- ----- . - - -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules annddGregulations of the San Joaquin Local Health District. <br /> - /- <br /> (Signed)---��ep— --'-----' -------- --......_.....__ --------------- ----.............__...._.---(Owne and/or Contractor) <br /> A/ <br /> By:.---C.�r +e.-��..--- G.T�A�...�9- --d-------------------------------....(Title)----.. <br /> (Plot plan, showing size of lot, locafio. of systa in ion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..... _.C�....-.-....__.------------. <br /> ................ ------------------ DATE... j.---,1r1-'_Ce-:------------------- <br /> REVIEWEDBY.---------------------------------- ---------- .................... DATE------_---------------------------------------------- <br /> BUILDINGPERMIT ISSUED -------- ---....... .................................. ---_------------------------------ DATE------------- ------------------------------------ <br /> Alterations and/or recommendations _..:- -`- "'----------------------------------`--"._-----'- <br /> -_-...._.I-_------------'------ - ------------ ----- --- -- <br /> -- --- -------- --- ....__... ----- .......::-- �- '---- -..... ------------------------- <br /> ----- <br /> ..... - -'---- - - .------------!----------------*--------------------.... <br /> ----------._................... '--------- ... .......--------- - r------ ------...---------------------------......- -' ---................. <br /> FINAL INSPECTIO :_.. .....- / <br /> 3 - 22 .— -- - ........ - --.... <br /> yf Date---...__ ------' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />