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FOR OFFICE USE: <br /> _____-_-_-___________________ APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------------------------------- (Complete in Duplicate) y 3 <br /> S -T-A,.r—ro J,- "- Date Issued t• �°. <br /> Sd-.-------------------------_--_-.. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compli nce with County Ordinance No. 549. /-�tl (7Eco , <br /> E 5:1 DF <br /> JOB ADDRESS AND LOCATION lc-M S � ' , _ _ . . . . .RAQF ----RD-------------------- <br /> - <br /> 5 . Q <br /> lOtCrN __ Ow <br /> wner's Name.----- ----66ROU - ---------- _R:! <br /> Address-.--' 06 AA-Ko7 AV !YQbF—' .... <br /> .px --I aej......1.M N.' ��4.... <br /> Contractor's Name._M._j)10Aj_l`).L.D...... , 71 - Si 11.L — -------- Phone----------------------------------- <br /> r <br /> Installation will serve: Residencei�Aparfinent House ❑/ Commercial ❑ Trailer Court.[]—Motel ❑ Other [I <br /> Number of living units: ._'.. Number of bedrooms _3.. Number of baths� Lot size .�...........� ------- ..^ <br /> i <br /> Water Supply: Public system E] Community system I-] Private ®/Depth to Water Table 12 ft. <br /> Character of soil to a depth of 3 feet: Send Gra el ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date... r�l No /`New Construction: Yes,�'l�lo E] FHA/VA: Yes 21--no ❑ <br /> r� -- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool ifted tif,public sewer,is available within 200 feet.) <br /> p t /, tion--,�� Mater al..�'QN C L .......L�F• <br /> Septic T Not of compartments. well...a .'-Size-&- <br /> -from fou,da Liquid depth...'��Z.._-----.Capacity_f�s��..... <br /> .. <br /> �-v DSA'. <br /> Disposal Field: Distance from nearest well---_5_0.....Distance from foundat• n_-.... -------Distance to nearest lot line-_5 ...._.. <br /> ( F Number of lines------22 •-- ..--------Length of each line. --..Width of trench.-._ ... <br /> .. p `i g ................. <br /> Type of filter material.-. ._a-�11.._._De th of filter materlal.....�.�...'......Total length ........................ <br /> Seepage Pit: Distance to nearest well_..................Distance.from,foundation.-_.....-..- -_._-..Distance to nearest lot line................. <br /> [] Number of pits----------------------Lining material----- _-Size: Diameter-------------..........Depth-------.----------------------- <br /> Cesspool: Distance from nearest well.................Distance from foundation.---_._7N........Lining material..--.---_-.-__-_-______--._....-. <br /> ❑ Size: Diameter------ -------------------------------Depth-----�-j-.....w`j'------•��!A -- -- ------Liquid Capacity---------------------------gals. <br /> J�Lik /• .w�� - <br /> Privy: Distance from nearest well-.-.---__-----------------------------_.____Distance from nearest building-------------.---------------------- <br /> ❑ Distance to nearest lot line.----------------------- <br /> Remodeling and/or repalnhg'(describe):...-� Ct_ 7A��K--=lniSE3L!- -_..___ 'ftoM-._.FN.Q.fTlon!____-_iO- -RQtnRE <br /> rM <br /> ' i � =7'`: {-•O- -----. .. --------- <br /> IR-t�-�-=----- -- LERCH + 0- <br /> ------------------------ ------------------------------------------ ---------------------------------------------------------- ------------' )------------------------------------- -------------------- ---------- <br /> I hereby certify that 1-have prepared this application and thathe work will be done in accordance with San Joaquin County <br /> ordinances, State I w a rule and regulations of the San Joaquin Local Health,Disfrict. <br /> (Signed v ( 1 --- <br /> ------------------------- ----------------------- (Owner and/or Contractor) <br /> v <br /> /�l 7 <br /> By:------------ -----------..-................----------------------------------------•"-..............•--------------------` --,--Title------- -- -- ---- - - - -- --. __ ......... .. <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 /> APPLICATION ACCEPTED BY---'-�......R'O- ---------------------------------------------------------------k--DATE.------ - -------- <br /> REVIEWED BY---- - ------------------------------------- ------ -------- DATEA.................-------- <br /> BUILDING.PERMIT..ISSUED.------_------------ ......,.---------.._x-------::.:: :Y- -:: Df4TE�== -`'----- <br /> - <br /> Aiterations T and/or recommendations:.....•---------------------------------------------i..--- ------- -----------------------------------------------•---------•---•------- ------ , <br /> . Nr`I . 16V11ai r: F"%# <br /> --.--..-.-.-.-.-.-.......................................--.-.-.L-_.--.-.---.-.---.---.--.-­..--.--..---.---.------------- <br /> ------------------- <br /> --------------- ----------_------------------------------------------------------------- <br /> ---------- <br /> ---------------------------------- <br /> ----------- <br /> ------------- <br /> ....•..........------------------------------ <br /> ------------- ----------------- ------------ ....................... ................. <br /> FINAL INSPE � Date-------------- 12-- .— ` '------ --- <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 /> ES 9 REVISED 8-59 3M 3-•43 f.P.CD. <br />