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FOR OFFICE USE: <br /> -­----------- ----------- - Permit No. Z- <br /> ... .. ..........; ... APPLICATION FOR SANITATION PERMIT <br /> ...........................I...................... . <br /> (Complete in Duplicate) Dahs Issued <br /> ....................................................... 0 Issued <br /> ......... ...... ..... .... <br /> ............................. -—- This Permit Expires 1 Year From Dat ibed.. <br /> to construct and install thit work her/-CIV Application is hereby made to the San Joaquin Local Health District for a permit P:&cA/-CIV <br /> This application is made )Iiaafe with County Ordinance No. 549. 1` - <br /> Z-A 7ME.- --------- .1 .... <br /> Q <br /> JOB A15DRESS A�Dil L0,'(!ATIONI----- --IN/------ <br /> Phone----`--- <br /> .....V <br /> Owner's Narpe.......VN3.3-F—D......­... ..... <br /> IV----------- --­---------­------- ----------------------- <br /> T1.0� .....3­6z.....W�r........ <br /> Adclress.:.�t.... <br /> 1 11 -� Phone-------- <br /> ---------- -r........... .......... ��............................................. <br /> Contractor's T C-Other [I DOPOEES( <br /> 0-Trailer-COU0 ,13 Ot <br /> Installation will some: s Reiidence Ek"Apartment Hctuse ornmen"a' 4C.4KA 6F <br /> 7 mber of bedroom: �o <br /> Number' f living units: _l..__ Number Y;, -ii <br /> ki;;hTy_�. Lot size ....CA <br /> Community system Pr. h�0Vater Table av ff. <br /> V, <br /> Water Supply: Public system U Private-0 Dept Clay[] Adobe[3 Hardpan C <br /> Gravel 0 Sandy Loam Clay Loam D I <br /> Character of soil to a depth of 3 feet: Sandj� No <br /> No;P--�New Construction: Yesig N FHA/VA: YesE] <br /> Previous Application Made: (If yes,clote............... ....) <br /> -- TYPE-OF INSTALLATION 'AND SPECIFICATIONS: <br /> (No septic lank or cesspool perr4itfed.R Public sewer is available within 200 feet.) <br /> IM t 'al.........----------- ------ <br /> So ank: Distance from nearest welr- It friDyfounclation.................... 7 "' P <br /> ---/A0 a do th--------- ------------- Capacity­, - <br /> > <br /> -.0 <br /> No. of compartrineilf'- <br /> Z.--------....SizeVxA-------- Liqui "a <br /> Pe I a ..9 ---- lenc to nearest lot lir <br /> s well/015;----Distance from found ti In 14 <br /> Distance from neare idth :f tranche....1.03.19. <br /> Number of lines ....... <br /> ...Total length---------I <br /> Jr <br /> �ia <br /> Disposal Field: -Length of each 11 <br /> 2 To <br /> me Sir jQj<i,---Depth of,filter plate <br /> _-,T.ype-oU1ItRr. I ion.. ­Distance to nearest lot line................. <br /> Seepage Pit 0 ;t well .........i--------Distance from founclat ............... <br /> Distance to nearest I ---- i ial ----------Size: Diameter.....:.................Depth.------------- ---------- <br /> ❑ Number of �jts------ --------Lining mater ---------- <br /> Cesspool: Distance from nealest well t- Distance from foundation....................Lining material........................---------- <br /> I '�-_-:.!---.Depth..------j ­ i.......................----------Liquid Capocity...........................gals. <br /> 0 Size:.Diamoier ... ....... <br /> ah&61FZr�hearest building_..---------------- --------- ---- - <br /> Privy: Distance fro... .. ......11 <br /> i......... -­------­­......... r`....---................................--------------- ......... <br /> Distance to!neares lot linea-.,,. ----------- <br /> 0 i t . I 1 � <br /> Remodeling and/or repairing (describ�):­.................----------......_-__--....••--I----------. -----_...-.•-------•._..--.••.......-.. .................7 <br /> ............ .............--------------------------------- ...... <br /> ........................------ .......... ....... <br /> ­............... --- ------------- f ....................................-------......................... <br /> --------------------- ...... --------------- <br /> ..................................... ....... J.. ------------- ---------................................................­4..-...._.I---------------------•----•----- ............I...... ------------- <br /> I he ce ify that h&4 prepared this application and that the work will be done in accordance with San Joaquin County <br /> a San Joaquin Lo4al Health District. <br /> ordinances; law rules e f th <br /> tat o ......................................... ....._(Owner and/or Contractor) <br /> ..............­-­ <br /> (Signed)------- F--: ... .... <br /> -- t ------------- ...... --------------- <br /> - ---------- ---------------------------------- ------- ................ <br /> (plot plan, showing... size.. of--lot,. location�f system in relation to wells, 6aildirIgs'-it.fc�,-cari..Iae-placed on reverse side). <br /> -F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- <br /> ............ . . - <br /> ­ DATE -~/r.--:....._ - .-`..._._.__. <br /> .................. <br /> REVIEWED BY-----------------------._.............l....---------------- ..........- --------- --­-------- -----. DATE --- <br /> ........­. <br /> .. <br /> ---------- .............. ........................------ <br /> I. BUILDINGPERMIT ISSUED--- . . .... -... .. ---------- <br /> ----------------........................ ......... .............�i- -- <br /> ....... ..................-..... .­­......­..-.-...- <br /> - <br /> Alterations and/or recommendations:--;--...__----- ------- .. ............. .. . . ...... <br /> -----------­------------ -----------....... ......................I... ... .!..........-------------------------- <br /> ................................................................ ...... -------- <br /> --- ---- ..-.-.-.-..-..-..-............. <br /> ............. M......................... <br /> .. <br /> ............. <br /> FINAL INSPECT NOBx��4fo ............... . Date... .. ......................... ... ---------- <br /> SAN jOAQUIN LOCAL HEALTH DISTRICT <br /> 205 Welt 9th Street <br /> 130 South American Street 300 Wert Oak Sn.,I 124 Sycamore Sliest <br /> Stockton,colifornic, Lodi,Californiam.ni.,o,California 7,0cy,C.M.'.10 <br /> ES 9 REVISED 8.59 zM 5-62 ATLAS <br />