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FOR OFFJCE 1.15t;. <br /> .......... .............----------- <br /> ................... .. .................... ..... APPLICATION FOR SANITATION PERMIT Permit No. _ .412_9aL- <br /> .......................----------...._._...I-----.._- (Complete in Duplicate) Date Issued <br /> ...............-------- ............................... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to 7 <br /> This application is made in compliance with County Ordinance No. 549. construct P-ifs;_lPthe work herein described, <br /> and insTa <br /> I PD/J <br /> JOB ADDRESS <br /> ATIC Jam....." 17-0 <br /> y <br /> ----------- <br /> Owner's Nam <br /> ST <br /> [L <br /> ------* . ... . ................. .............. Phone-5-,77. <br /> Address-------...---Rrja_.....................18a>.� t Ajm.04 ._ <br /> Contractor's Name.....90.W. .W_F__ Z_._... -- . .......................................................................................... Phone.: --_........................ <br /> Installation will serve: Residence M- Apartment House 0 Commercial [] Trailer Court E] Motel E] Other [] <br /> Number of living units: __1---- Number of bedrooms 2—Number of baths ).... Lot size ACRFA6��.......... <br /> Water Supply: Public system E] Community system El Private P_15epth to Wafer Table V. ft <br /> VIEFty <br /> Character of soil to a depth of 3 feet- San Grove[ E] Sandy Loam [-] Clay Loam ❑ Clay [I Adobe[I Hardpan C]i <br /> Previous Application Made: (if yes,date---__ .......... I N - FHA/VA: Yes El <br /> o ja"'INew Construction: Yes ❑ No E� 40 <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..._...............Material........................... <br /> E��/46- No. of compartments------------- . ........Size.............:.................Liquid depth,.... ... ....... ....... Capacity...------ .......... <br /> Disposal Field: Distance from nearest well...-�----Distance from foundation.....�4?.........Distance to nearest lot <br /> F_)[[�)1A6Cw- Number of lines..---------/......................Length of each line.: --- ----Width of french.------ <br /> A D.15 Type of filter material.8-P Cr�......Depth of filter material..---/.?-----.-_--.Total length.........3:5�� . .............. <br /> . ...... <br /> Seepage Pit: Distance to nearest well......................Distance from foundation------------_-----Distance to nearest lot line....-----....... <br /> El Number of pits... ........._._-_.Lining material...................... Size: Diameter..............._......Depth.........................._..... <br /> Cesspool: Distance from nearest well................Distance from foundation_.............. . Lining material...................................... <br /> F Size: Diameter. .. .............. ................Dept k.......... ............................ ..----.Luid Capacity----------------------—.gals. <br /> Privy: Distance from nearest well........................................._-.....Distance from nearest building....__.-.,--..------........_.".__. <br /> El Distance to nearest lot line............................................................................... <br /> Remodeling and/or repairing (describe):........ - -----4_4----N_-F_-7-------1P F1------- <br /> .__IV ----- <br /> .............................I.......----------­—.11...........­.­.......... ...............................................................................................--------------__-- ---------- -- <br /> -- <br /> ....................... ...... .................--------­­.......................... -----------------------------------------------1-1------------ -------------------------------------- <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 and regulations of the San Joaquin Local Health District. <br /> ................................................�; -----.(P*ner and/ Contractor) — —1 <br /> fir. <br /> By:----------------------------------------------- -----------_.................... ... .......................................( ifle)................ ............... ... <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 <br /> REVIEWED BY--------------------------------......................= --------------------------.---------------------­-----­-------..... <br /> *----..-----­--------- DATE------------ ----------------- <br /> 1 ......... .............. DATE-- .......... <br /> BUILDING PERMIT ISSUED-------- - ................................................................................ DATE...----- ---------- <br /> Alterations and/or recommendations:----__--------- - _.......------------- -_------------------------------------------------------------------------------------------- <br /> ..................................................................------------------------- ---------------------------------------------­----------------- --------------------_----____......­......­­ <br /> .................................................................................. .......................................... ...... ................................... .............................. <br /> ------------ ...... ....... .. ....................... _ <br /> ­_­­.......... . ........ ­........................* ----------­------------­­ <br /> ................................................. ......... <br /> FINAL INSPECTICiN-At__-,e'_-,'.0R' Date.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.His.eltor,Ave. 300 West Oak Street 124 Syc.mairis Street 205 West 9,h Street <br /> Stockton,California Lodi.Callf.r.la Manteca,California Tracy,California <br /> E.H.9 21A 1 61 Vanguard Pres, <br />