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FOR OFFICE USE: <br /> -------------- <br /> r .... <br /> .....................................................::. APPLICATION FOR SANITATION PERMIT Permit No. ----- --.- . <br /> ------- ----- ---------------------------- ------It. (Completwin Duplicate) /.� -2G6 <br /> .I- This Permit Expires 1 Year From Date Issued Date Issued _.-__._.. 7 <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 ismade in compliance with County Ordinance No. 549. <br /> ., <br /> JOB ADDRESS AND L0CATION-----A�.,.1k_._ �i� ?rl.,:e= <br /> Owner's Name----•-. �sna- .1 •.r!1 ------•--•--. ----•................:.......••--.----•-.-- ......__... Phone-----.--•-----------_---•------ <br /> Address /r2rs.? --•----•-------•-----•----•---------------------- <br /> .---•-•--y - ....... <br /> Contractor's Name-----�.... aav- ----------------------�-4.. ---------........ --........-•-..-----.0......---._....------. Phone. <br /> Installation will serve: Residence Apartment House 1] Commercial ❑ Trailer Court E3 Motel E] Other E] <br /> Number of living units: __�..._ Number of bedrooms . Number baths_._- Lot size ----- --- .....-----•-----•-•----_... <br /> Water Supply: Public system C1 Community system E] Private Vepth to Water Table _-Z-ft -t-- <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sa dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: -(If yes,date----------- ---- I No 0 New Construction: Yes [B No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or-cesspool permitted if public sewer is available within 200 feet.) <br /> Septic nk: Distance from nearest well._ i <br /> .._��___.Dis#ance�rom foundation----A.._......Maternal___._..._.__c .......:........ <br /> No. of compartments_.. _2 _Size..s.-k 4_x/Q i uid de th....•i�-. .Capacity../,5:00! ff7t <br /> Disposal geld: Distance from nearest well..-.--'..Distance from foun ton.._..Id........Distance to nearest lot line..:.-__-- �.-.. <br /> Number of lines........._____....____ Length of each line.. ..... Width of.trench........_-o2.�.................. <br /> Type of filter materia y� <br /> YP ���*-��-Depth of filter material...... length..........��?...._________________ <br /> Seepa Pit: Distance,to nearest well-----/M..._....Distance fr m f undation__-/.�_._.-------Distance to nearest lot line../A........ <br /> Number of ptts... ..A__---.---Lining material... ...Size: Diameter..._*3.c-_._......_Depth.......�r............... <br /> y. Cesspool: Distance)from nearest well ................Distance from foundation...................Lining material.............._...-------------------- <br /> i ❑ Size: Diameter- -- ----------••- ----------------Depth, -•------------ <br /> ...................................:Liquid Capacity......_........_--------- gals. <br /> r Privy: Distance"from nearest well.....................................-...........Distance from nearest building.--.._.._____-.__..._.............-.----:- <br /> ❑ Distance,to nearest lot line............. ......... ... - - -•- -----------•-------._--.-...---•--------•----.-..-.._.---------------. -... <br /> Remodeling and/or repairing (describe):_._44w_X ..— - _.._..____-. f �lcf � _. rl '?.G1 .4 <br /> ••-----••-•---•• f -------------W--- ----- ------ --------- ------.....--- •--- ---•-- ...-- <br /> ' .�tl.�_.0-�`a?- 11 _aC�.4 -f --•/�K.+^ ------------------------ <br /> _kyf---- ----- •----------------------------- <br /> --- ------------------ .---------•--------- _.. ------------------•--••---------------= <br /> I ftereby certify that I have prepared this application-and that the work will be done in accordance with San Joaquin County <br /> ordinances,?SI.aa laws, and rules and regulations of the San Joaquin Local Health•District.(Signed} �; - ............... ....................................... .......... (Owner and/or Contractor) <br /> �� _r s?....•-- ..._...--..........:...... - ------ <br /> By:, Itle -c.c�e-tJ <br /> ----- <br /> Y: } -sic.............. <br /> (Plot plan, showing size of lot, location -s em in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> i - <br /> APPLICATION ACCEPTED,BY..._._. V. DATE...... 03_..2-6 .. - .--- .- -- <br /> REVIEWEDBY-----------------------'- --------_-------------_------------------------------- ......------....... ........_ DATE..............................----------.......----- <br /> BUILDING PERMIT ISSUED_—.. .. ................_ --.....-•---. ........ .......................-..--------------. DATE-- --------------------------------------- ---- ...... <br /> Alterations and/or recommendations:-...... ..................... ...... ..................................-............... ----------- -----.... ..... . <br /> ------_-----.-----•------------- ---- ...................................----------..............................---------- ............-•..............------------_------•-------•-----------••------••-- <br /> ............. ----------------------- ................... -- ---------------------------...-_-------...-.......................................-........................ _--------- ..... <br /> ...--•--------...........-------......................... ..:........-................._. .....---------...............-..................................-....................................-----------------I.......... <br /> l ... . ............._.......•........... - -------- -- - -_-------- ----- -------------------­-­- --....----.._._...--------•----• ......................................................... <br /> j u �- <br /> FINAL INSPECTION BY: e..Cl� 0,f. -Y Date....1-2...... <br /> 1 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi.California hionteco,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />