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r%,,K vrrit-t Ubt: <br /> IF . 10 <br /> ..............I............................. <br /> ....... <br /> ............. .............. ..........­ .............. APPLICATION FOR SANITATION PERMIT Permit-N0, ;Z_-Z,9— e <br /> ..................................................... (Complete in Duplicate) <br /> ............ ............ I.............. ........­ This Permit Expires I Year From n­ Issued Date Issued .421_� !nG1 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construe and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.J..-CHS 1V_X 3 <br /> Owner's Name,!5"�f <br /> .WW&AW.....D 0. 1---------- -------------- <br /> Address_.- ........ <br /> .......... ..... <br /> Confractor's---Na*��.... <br /> so.ovs...f- <br /> installation will serve: Residence Apartment House 0 Commercial [I Trailer Court [-] Motel El Other 0 <br /> Number of living units; .-/... Number of bedrooms 4/ Number of baths _L..... Lot size ..le..f <br /> Wafer Supply: Public system 0 Community system El Private [I Depth to Water Table ........ ff. <br /> Character of soil to a depth of 3 feet: Sand L] Gravel El Sandy Loam C] Clay Loam [3 Clay 9 Adobe 0 Hardpan <br /> ❑ <br /> Previous Application Made: (If yes,date......... ..........I No 5� Now Construction: Yes C3 No K FHA/VA: Yes El No)Q <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well..____..__.....Distance from foundation---__......... <br /> []&ES,kjAjC NO. of compartments..................... _...Materiel............................................... <br /> I -----Size------------------_-------._Liquid depth-----------._..........._...---Capacity---------........... <br /> Disposal Field: Distance from nearest weizs ....Distance from founclation.—W!..._Distance to nearest lot line_.A� <br /> 9 Number of line Ci. <br /> i Type of filter s_ i------ ----- ­ ------Length of each I;ne..ZAO-!! ..... .I Width of french...:?-..4-.!_' <br /> material._ .. .....Depth of filter material...... length....��iO.f - ----------------- <br /> i ......................... <br /> Seepage Pit: Distance to nearest wei.70---- -------Disfande am undation..._:s7W.....Distance to nearest lot line.;.70 0 <br /> Number of pifs_.40A1.r......Lini 42k. Size: Diameter----3F.;3 Is . ..... <br /> --------Depth.--.. V------------------- <br /> Cesspool: Distance from nearest well--------- -----Distance from foundaf ion----------------- Lining material............. <br /> 11 Size: Diameter.................... ... ---- ---- Depth- -------------------------- --------------------Liquid Capacity.----------------......gals............ <br /> Privy-. Distance from nearest well........_...__._.._ <br /> -------------_----------Distance from nearest building.... ..............- <br /> Distance to nearest lot I;ne., <br /> Remodeling and/or repairing (describe):........ ........... <br /> 1:102�axe_ - . . _ " , ----- ............................... <br /> ........................4C .... ............... .... ...... <br /> .................................... <br /> -------_------ ------------------------------------ <br /> .. .. <br /> .......... ..... ...... -- ---- <br /> .. ... ... ... <br /> ­... <br /> ................I............... --------------.......... ................ -------------­............................................ -------...................­............ <br /> hereby ce a trepared this application and that the work will be done in accordance with San Joaquin u <br /> 1 1* .1 <br /> Ordinances, Swl!rl�a-s, end rules are' regulations of the San Joaquin Local Health District. cc Cc rify <br /> ........... <br /> (Signed�.� iq 4:1 <br /> A <br /> By:----------------- .... <br /> .. ..... ... (Owner and/or Contractor) <br /> (Plot plan. showing k��jf I f ------- --­-----------­ <br /> 0 0 , location 0 system in relation to wells, buildings, etc., can be place on reverse... ..{Owner <br /> eFOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... . - . DATE__,A!!_.)-__7' <br /> REVIEWEDBY........----------_---__..................................-- ---------------------- ......... DATE------ ..... ......................... <br /> BUILDING PERMIT ISSUED_......--------- .................. -------- <br /> -- <br /> .......... <br /> ........................ ..........__...............--_-----_------------ DATE <br /> Alterations and/or recommendations: <br /> ..........I............................................. ............................­........... .......................--------- ------- ...................I----------­.............................. <br /> ...............I----------- ------.......................­­---------.. ......................................................... ...................................­-----------------------.......... <br /> ........................... ..........................­­­------ ................................ ....... ...................­�---................................................................ <br /> ........ ..... .. ....................... ..... ........................­................."Date. <br /> ....­­.......D..e..t.c..................... ..............._.......................... <br /> ­ <br /> FINAL INSPECTION ------------------- . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.H...It.e Ave. 300 West Oak str"t 124 Sycamore Street 205 W"t Sith street <br /> sra<kren,California L.di,California M.me,a,California Lacy,CaliForniv <br />