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FOR OFFICE USE: / <br /> ............. APPLICATION FOR SANITATION PERMIT Permit No. 5'! <br /> ------- .. ... .. . <br /> _. -. ..'---......... �.....--- ... (Complete-in Duplicate) <br /> ... This Permit Expires 1 Year From Date Issued Date Issued l _- _tt��, <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 mode in compliances with County Ordinance No. 549. 5r Vy#(tu/j;j 4_0_ rQ/! <br /> 2C-,4 �r <br /> JOB ADDRESS AND LOCATION.z�`�`wi"�`1.-Af e/-_T: � -D f z`tQ�1',OI +� ��}�N <br /> Pho <br /> Owner's Name' qY:�:1/_e`,�.-.-fl . ...... �C�.Ce----/�-��-'�•0.1� •----.................. •-. <br /> _e�lL3 ........................................._.. ................... <br /> t I. <br /> Contractor's Nam—I /4�.�f-�19/i ........ ............ Phone ��rQ-",3-d.C�I <br /> 1 <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: _- ._. Number of bedrooms j....-- Number of baths_...- Lot size ..-._ .-. ------ .. ! <br /> Water Supply: Public system El Community system ❑j Private Depth to Water Table <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ( Clay Loam ❑ Cloy ❑ Adobe C] Hardpan ❑ <br /> Previous Application Made: (If yes,dote.- J No ❑ 'New Construction: Yes ❑ No ❑ FHA/VA: Yes C No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: (� ''. 1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well/400..__Distance from found tion.� ........ <br /> Mater I "OfZG LL°- . ...... <br /> f C� <br /> No. of compar+e,nts-. �- Size 7C�f{ .� 3iqud ciepih_-.�rr....... Capocity.,�_ ..... <br /> [ 7 <br /> Dispos 1 Field: Distance from nearest well.� .amu' Distance from foundation.../0.---....Distance to nearest lot line-_m� ..- <br /> Number or' lines_..�-�___ ...._. Length of each line.. -./ �.._.....Wid+h of trench. _Sita. <br /> © . .. ---- ------ <br /> ` I , Depth of tilter mates•.------- 9 ----------- v <br /> I Total len to <br /> I t f �.�... f 0 <br /> Seepage Pit: Distance oftoenea strlwe'.i.......... ..... . .Distance from foundation................... Distance to nearest lot line.............. .. <br /> Y� <br /> ❑ Number of pits.- ..+......... Lining material-- ------- Size: Diameter ---.-..--..._ ....Depth. .........----.._ V <br /> • r •1 d <br /> Cesspool: Distance from nearest well .........Distance from foundation...._.......... Lining material........... _•.•__._....._ <br /> ❑ Size: D;ameter_ . Depth-_ .. .......�_........__._---___LigL d .....gals. .\ <br /> _Dig+arse from nearest building ...---. <br /> Privy: Distance from nearest well..._-.._.�P...�.----......_. -......_... 9 — -•- - ^— <br /> Distance to nearest lot {ins ...-....._ .................... ..........................._....»....--- <br /> Remodeling and'or repa;rir.g•(descriue):_ ----- ..... .............. .... ............_.._--_.--.----_--•-,�.—___.....__..__... <br /> { _ _ <br /> _......_....... - _...... i.r/t.q..l_.( Y.47` Pf /S:f i0+�.-.--._---_-_--_---..-------_-.--------:--- -- <br /> _..........-- ..............-__....._............---------.---...... ----------- ......---••-•--- --•-- <br /> r <br /> 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 /> DAY `, <br /> (Signed)__. ;......�e-Tank-Seirv*oif-- (II' er Contractor) <br /> i SHO ,, . P (Title)_ <br /> By:.. ............... <br /> ---- S�tikfvn, ILS:... . ........ ... :.-.._. .. . - - _-..._ <br /> (Plot plan, showing size of lot, location o�syatem in relat• to wells, build' gs, etc., carPbe placed on reverse side). <br /> . .]me- -01FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_j(..! .. . ..... .......------------------ ...- .....-...... DATE..IJ:.�.`G.,c......---------- - - - <br /> REVIEWEDBY .. ....... '_....... . I ............ .._ . .. .... . .. .... DATE---------------------------------- ... ...... .. ---- <br /> BUILDINGPERMIT ISSUED..-----------'..... . .......................... .....- ............. ...... ...... DATE...............------------------..------ ------.... .. <br /> Alterations arld/or recommendations:.Z&eR�`e.4A - .- .r.3- Si--. t_---' ........ <br /> ' <br /> _ ------ __.... .. ........ ... <br /> �6FINAL INSPECTICN BY: Date........ '6 -7-------- ------ -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1501 E.}lareltan Ave. 300 West Crai Street 124 sycamore Street 205 West 91h Street <br /> Slocklon,California Lodi California Manteca,Californio Tracy, California <br /> E.H.9 2M 1.67 Vanguard Press <br />