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­V- <br /> FOR <br /> V-FOR OFFICE USE: <br /> PERMIT Permit <br /> r <br /> • I . <br /> " " " '.. .............................. <br /> """ " "" APPLICATION FOR SANITATION ` <br /> I ......................................................... (Complete in Duplicate) Date Issued b3 <br /> This Permit Expires 1 Year From Date Issued per. <br /> Application is herby made to the Sen Joaquin Local Health District for a permit to construct and install the wo ere detenbed ; <br /> This application is meds in compliance with County Ordinance No. 549. }�• <br /> q� a <br /> :rf JOB ADDRESS AND LOCATION..............�..j...G..... ......_.. ,.....f...... . 7,3 <br /> Phor .7r. <br /> i L/...0`_.. .Q.r.. ............ F-7ti�y yq <br /> r <br /> ,Owner's NO me.................�v' .... <br /> f <br /> Address.. . ....... Phos._: <br /> t <br /> .._.Contractors Name......................�.(lf.:'-/?.t?../.�........... <br /> Inst will serve: Residence Apartment House ❑ Commercial ❑ Trei Court ❑ Mot ❑/� <br /> Other ❑ y ^ <br /> • .. ". 2. Number of baths 1 Lot size __........" <br /> Number of living units: ..... Number of bedrooms... <br /> Private Depth ro Water Teblag�ft• � r;;; ' <br /> Water Su Public system ❑ <br /> Community system ❑ Adobe 'He�pen " <br /> Gravel Sandy Loam❑ Clay Loam(g/Cley❑ <br /> Character of soil +o a depth of 3 feet: Sand ❑ ❑ �FHA/VA Yes❑`yNo❑ ;�`v :' <br /> r ....) No ❑ New Construction: Yes ❑ No . ire" �sWy <br /> Previous Application Made: (If yes,date- <br /> STALLATION AND SPECIFICATIONS: V' <br /> TYPE OF IN r ',.� : <br /> (No septic tank or cesspool permitted if pudic sewer is available within 200 feat.) i <br /> c • .':y. <br /> /�� Distan c� rRm foyndet�onl��n�•.Material............. ��•� <br /> Distance from nearest well a1Fr�• TG7f/ <br /> Septic Tank: _/ (^^ Li aid de th. ... .....Cepauty_ kk <br /> t No. of comF 5rtments........ T.....Size.. <br /> OQ Width of trench..... -•�r',< +K: <br /> Disposal Field: Distance from nearest ell.�Q.,�J111.Distance from foundation_/�..NII!'1•t••Distance to nearest lot li :•w•-••+ � <br /> A ... Length of each line.... rr ,�. <br /> Number of lines.------._� <br /> Type of filter materiel �'0�{ Depth of filter material Q"-•-•,-•Total length........... <br /> r !zF)is+e+rxe�f <br /> / i e or._... ep <br /> Seepage Pit: - - ..Distencfyfio'nearest' I w"Jp�.:� <br /> -Numberof pias.... L•Inin metenalaP ."-- . .. . - <br /> Distance from nearest well................ Distance from foundation.......----•••-•-•.Linindg Ca meteecil ?qe� ? <br /> 3 <br /> I _ <br /> Cesspoo: Depth.- Liquid P fi' r ��Y <br /> ❑ Size: Diameter............................." P Distance from nearest budding --•• <br /> .... <br /> Privy: Distance from nearest <br /> well..................... ....... _.... ........_ ............__. <br /> ........................... <br /> .............�..... <br /> Cl Distance to nearest lot line...-__...- s }3v + 5 <br /> modelin end/or repairing (describe):.....-"- <br /> . �`�•>� <br /> . .......... <br /> ... .....I M <br /> } .............. <br /> . <br /> L7.►'.....f ....................... <br /> rrll � fr <br /> ••••••••-••••-•• licationjnl. <br /> + the work will be done In accordance with San Joaquin County <br /> I hereb certify that 1 have prepared this app F <br /> rules end re tion +he uin Local Health District. <br /> ordinances. tato la ..............(Owner and/or Contractor) <br /> {: ....... <br /> ... .:....... <br /> r f, L�I•J...... ... . <br /> ($i ned <br /> 9 )....... (Title) <br /> By:............................................................ <br /> P1tem in relation to wells, buildings, 6+c., can be placed on reverse ). <br /> rse side <br /> ( o+ PIan, showing sire of lot, location of sys <br /> •.'>� FOR DEPARTMENT USE O Y <br /> T_Y _ 7 <br /> DATE............:........•......................:..._._......_ <br /> APPLICATION ACCEPTED BY........................................................ <br /> ................. ........................ ..._........... ... <br /> REV;cWED BY................................................ <br /> .. ..............................._......................_. <br /> ........... <br /> r DATE <br /> BUILDING ............................................................. ..................... .............:....� <br /> PERMIT ISSUED <br /> .VR or recommendations:......_....••••• •..... /�L u...... <br /> Alterations / ..... Y-:....._.� y../�;yl.. ..... i. 3 ri <br /> ,` • .���� ......w...R................ F ... � ............................ <br /> 1 ....... <br /> �/r <br /> I'P .....f.............. ./.`.: :`.................. "�r�I�!/t-�,l�.... ... �r i f J .....•. .`=........ <br /> l..........................�r rll ..... ......_................ ..... :.......... .. �... <br /> ­!•�iiJiL� f <br /> Date.......................................... _..................... <br /> FINAL INSPECTION BY:................ . ........... <br /> SAN JOAQUiN LOCAL HEALTH DISTRICT <br /> 124 sycamore Street <br /> 205 west 9th street <br /> 300 west Oak Srr�N Tracy,Callfornlo <br /> 110 Sough American StreetLodi,Calllornla Manteca,California <br /> Stockton,Californ;o <br /> ES 9 {irvISED 8.59 24 5.62 ATLAS <br />