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f:e: ^ FOR OFFICE USE: <br /> - - -' ------------------ <br /> - - <br /> .............__..._...I. APPLICATION FOR SANITATION PERMIT Permit No. <br /> -- <br /> - (Complete-in Duplicate) <br /> - T- - -- _ _ I P Date Issued ..............j{�. <br /> '.__. .... ..._...................__.____..._.-.__- This-Permit Expires 1 Year From Date Issued - 0&0 ^3Q <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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LO TIO1 /_Z-U.---- <br /> Owner's Name........ . . hone 5 1`ll- �_� <br /> Address------'-------------------`--------'Po..._Q.R....... .Q..X....�..�7. -. -----�.�. �1 - <br /> 14Z............................ - <br /> - .. <br /> s, c I'iCbntractor s Neme---. ......A.F+-'-R`-1=-�- ----- -------_---�1�----Q-ATS.--------------------------------- -------- PhonellC6 � O <br /> :;�° <br /> Installation will serve: Residence [? Apartment House ❑ Commercial ❑. Trailer Court ❑ Motel Cl Other ({)/Atgg� O <br /> s' Number of livingiunifs: .0..... Number of bedrooms _'.v Number of baths"-------- Lot size _.. __._._ _ .__._ ---------------- <br /> I <br /> Water Supply: Public system ❑' Community system [IPrivate lg-Depth to Wate_PTi6Ie.5D.'ft"' ` <br /> } Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam, Clay Loam C1 Clay El Adobe C] Hardpan ❑ <br /> Previous Application Made: (if yes,date.�"-..`--_ ._..) No 5iL New Construction: Yes ❑ NoA FHA/VA: Yes ❑ No X <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:- <br /> r— -(No-septic:tank-or-cesspool=permitted if-public-sewer'is availebla'wlthin-200 <br /> Septic Tank: Distance from nearest well........:.!......Distance from foundation....................Material........... <br /> ............_._..--................. <br /> E . \ <br /> ]&S,&A26 No. of compartments..._._..---..:.....{_Size.............:_....--.._...._Liquid depth......... ........--.-. Capacity........_....--........ <br /> Disposal Field: Distance from nearest well __`{-Distance from foundation...-,_+---------.Distance to nearest lot line................. <br /> ❑ Number of lines........f.....................4.Length of each line.-_....._.....................Width of trench --------------- -------------- <br /> Type of filter material.............._...-...-.Depth of filter material................_..._Total length._.-......._..._._.._...-.__........_ <br /> . I I r P <br /> Seepage Pit: Distance to neare t�•ell-.vZllP..........Distanc�j�rom/°undation---0?10 .._..4SttnFp to nearest t line--- <br /> % Number of pits_' _..._...Lining material. ?aJ(.-__ Size: Diameter.. .,rl..._......Depth. �.....F . ._. <br /> Cesspool: Distance from nearest.well ................Distance from foundation................. ..Lining material..-------------------------_ ...... <br /> ❑ Size: Diameter--- ---------------------------Depth......._... ----------------Liquid Capacity........................ <br /> ....gals. <br /> Privy: Distance from nearest well-------------------------------.....................Distance from nearest building- _...._..__._.._.__..._.._____ <br /> I ❑ Distance to neare.. s+,Iot:line.......... ...... ...... _ __- __-__..._..........._..............___.._ <br /> �..A.. __. V, <br /> r Remodeling and/or repairing (describe)':..._... - - -- ----�. .................... . ....... . .. --- . <br /> 1 <br /> l �i <br /> -------•----......................_--.....--......_...--'-----'-------------................... -....... <br /> ....--------'--------- - --------- <br /> s <br /> I hereby certify the+ I have prepare td this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, an d re4ulations of the San Joaquin Local Ililealth District. ! 'S <br /> (Owner and <br /> (Signed).....................__-._. _.___....._..cff_�...�.... ._. ... S.. SP/../V. . :t. <br /> — .O /or Contractor]] <br /> - y .� <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be place on reverse side). R <br /> FOR DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ - ----- .._...-'- - -.............................----- DATE---./.` 2.. .^._�_....... <br /> REVIEWEDBY-------------------------....._ ..- ----_-----------------------......-----------.----------.-------------- DATE..................... <br /> BUILDING PERMIT ISSUED....-- -- ------------------------------------------------------- DATE--.--------.------ . .....--.........--- ' ....... <br /> Alterations and/or recommendations:.---....................---............................_.........--___.:-. - .---------._..................................._--_-- <br /> ---------------....................... ...............-.......-------.............--.---.............--/-- ---------.------- <br /> ........_..............._---------------- <br /> ---..._. <br /> .............__...---_......_...... .......... . ..... .............._1... .... ).....). . ._......----'..-. . ......._'----._......- ......-•--- .--_.._ ............................ <br /> .....- <br /> FINAL INSPECTI Y: �1�{ � - _------ ._ Date.--_.-.-/-_`--�� ---�.lJ.. _... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hotelier,Ara. 300 West Oak Street 124 Sycamore Street 405 Wast 9th Street <br /> 1Stockton,California Lodi.California Manteca,California Tracy,California <br /> E.H.9 2M i-67 Vanguard Press <br /> i, <br />