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FOR OFFICE USE: <br />--------------------- ----------------------- ----------- '3 APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br />-------------------I------------------ -- -------------- <br /> -------------- ------------------------ ----------- Date Issued <br /> -------------- ---------------- -- This Permit Expires I Year From Date Issued <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 complia9ce with County Ordinance No. S49. I <br /> C-7 . ; <br /> Z vt:54��­----------------/---- <br /> OCATIV -- -----41-1,t-,1 <br /> JOB ADDRESS AND L ----S0 _0F <br /> Owner's Name--------4 ---------------------- <br /> _ax ---J�5--------Fm�--------��­5 6n - - --------- Phone-------------------- ----------- <br /> ------0 itA <br /> Address--------------P..' avx----------PZ_9------------41. _TOR PP---------------------1-------------------------- ---------------------------------------- <br /> Contractor's Name___M)9_N_TF-K.A------- IV 07 ------7MTKA MA F14 - Phone------------------------------ <br /> 557-,-- . E-_ - -_. <br /> Installation will serve: Residence od,-Apartment House ❑ Commercial [] Trailer CourtMotel F Other F <br /> Number of living units: j----- Number of bedrooms _� Number of baths I-_-_- Lot size A ------------------------ <br /> Water Supply: Public system E] Community system [] Private Z' Depth to Wafer Table 1:5-ft. <br /> Character of soil to a depth of-3 feet: Sand E] Gravel [:] Sandy Loam 2-'Clay Loam Clay ❑ Adobe E] Hardpan E] <br /> Previous Application Made: (if yes,date---.---.__---------) No New Construction. Yes E] No [�FHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND'SVEOFICATIONS: <br /> (No septic tank.or cesspool pe;miffed if.public sewer is available within 200 feet.) <br /> t7 A/C <br /> So t' T k: Distancefrom nearest well--,454)------Distance from foundation---/6---------M f - I - __ ET F-7 ------- <br /> a�eV---- ---o�--- R...... .. <br /> Y---- <br /> z 5 -_--.Capacity-----------------------,0 a <br /> p No. of compartments-----.. <br /> -277n------------Si e--,3-X 6 X, ...Liquid depth----- V2� <br /> Disposai Field: Distance fromnearestwell._SZ.....Distance from foundation-----/0 Distance to nearest lot --------- - <br /> Number of'lines--------- ------------ ---Length of each line----_-/,620-.-_..f_--,.Width of french------ <br /> Type of filter -------- <br /> -ma;e6J'e, <br /> al___RQC ___'_D'epth of filter material------17- g <br /> -------Total lenth ------------- ------------ <br /> 1 0' <br /> Seepage Pit: -Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------- <br /> ❑ Number of pits-;I--------_.......Lining material----------------------Size: Diameter.----------------.-----Depth-----.-- ----------------------- <br /> Cesspool; Distance from nearest well-----------------Distance from founclation------------------- Lining De <br /> Size: Diameter- - Depth---------------------- -------------------------Liquid material_____-_------_-_-__---.-------_-_- <br /> E1 - <br /> i ------ -------------------------------------------Liquid Capacity-...------------------------gals__;------------1--l-r---- --------- <br /> Privy: Distance from nearest well--*-----------------------------------------­-Distarce from nearest building---._----.--- .----.----------__.___-.-.-. } <br /> ❑ Distance <br /> uilding--------- -------------------------------- <br /> Distanceto nedrest'lot line----------------------- -- ------------------ --------------------------------- ------------------------------------------- ------------- <br /> Remand/or re a�6ng (descril�e�:------------------------------------------------------__------------------------------------------------ ---------------------------------------------- <br /> p wllll -or i <br /> ---------------------------------------------------- --------------------------r----------------------------------------I---------------- <br /> ---------------------I-------------------------------- ----------------------- <br /> --------------------------------------------- <br /> ----------------------- ------------ ------------------------- -----------------------------------------------------------------------------------------------------7 <br /> I ------------------------L-------------------------------------------------------------- <br /> -------------------------------- ----------------------- <br /> ,.------t ------------------------------ ----------------------------------------- <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, Stat laws, and rules and regulations of the San Joaquin Local Health District. <br /> --------------------- -----(Owner and/or Contractor) <br /> ------------------- <br /> (Signed)----------- e-,r-,tz_ -- ---- <br /> '3 -----------------------(Title)---------------- ----- --------------- ...... ---------- <br /> By:-------------------------------------------------------------------------------------- --- <br /> affT-s "n' -reverse side). <br /> .(Plot-plan showing sizb-6f--Idt7lotatiti--6f-system in relation;f o wells,� buildings, etc., can be placed on <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.................. --------- ------------------------------------- DATE------ ------------------------ <br /> REVIEWEDBY-------=----------------------------' -----------------------------I------------------------------------------------------- DATE------ ----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------I--------------------------------------------------------:---------- ----------------- DATE--------------------------------------------- --------------- <br /> I' Alterations and/or recommendafionsl------------------------------------ ---------------------------------------------------------- --------------- ---------- <br /> ----------- -------------------- <br /> WAS-----14f�TA_1_ <br /> 4t-F-D--------WI-Tt ------ <br /> -------------------------- ------ --arz. <br /> - --------W4 5---------a-A clK F__1 24n ----------&UF <br /> -------------------------- <br /> mq5 M-tq ------ <br /> -D-F------------------ ___F----------- ----- ---------- ------------- <br /> -------------r.........._-------------------------------- ------------------------------ <br /> Date-- ---------------------------- <br /> FINAL INSPECT1011 _1,9�W- In <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />