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FOR OFFICE USEi <br />Application is hereby made to the San Joaquin Local Health District for a permit <br />This application is made in compliance with County Ordinance Na. 549. <br />2.- ,44/ <br />:JOB ADDRESS AND OCAT1ON Ja <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />This Permit Expires 1 Year From Date Issued <br />to constrUct and install the work herein described. <br />-) 00 7 c5.- 0- 2-2.. <br />Permit No. Ae) <br />Date Issued /2-6 - <br />Owner's Name Phone <br /> A .. •• •••••••“. ..kay•a••••,' ••••••• •••••••••,••••• • <br />--t <br />Contractor's Name_-_ <br />Water Supply: Public system 0 Community system D Private arDepth to Water Table - ..... ft. <br />Installation will serve: Residence Apartment House 0 Commercial. 0 Trailer Court 0 Motel 0 Other 0 <br />Previous Application Made: (If yes, dote...... I No 0 New Construction: Yes 0 No 0 FHA/VA; Yes D Character of soil to a depth of 3 feet: Sand (3 Gravel 0 Sandy Loam 0 Clay Loam 0 Clay 0 Adobe 0 Hardpan <br />TYPE OF INSTALLATION AND SPECIFICATIONS: ; <br />Se- Distance from nearest well. -9r) ' Distance from foundation-to.' Material_ ..42-4,-*--.1...i.c, <br />Dispos i ci: Distance from nearest wel e-C4' r Distance from foundation - ic <br />Seepage Pit: , Distance to nenrest well _ .DistanCe from foundation Distance to nearest lot line <br />Cesspool: Distance fl•om nea <br />-rest wall._ _Distance from foundation . . Lining material A. <br /> <br />Privy: Distance from nearest well . - . . Distance from nearest building......- ... 4......--- - <br /> <br />0 Number of pits . Lining material Size• Diameter Depth <br /> <br />0 Size: Diameter Depth ./ _ _ Liquid Capacity 4--/. <br /> <br />Li Distance to nearest lot line ......... _. — <br />Number of living units: . L. Number of bedrooms "'Number of baths L. Lot size -3 4.---•4:-.--•-=1 .-. - <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />No. of compartments ' Size 5-ril .5-',,./...5- Liquid depth 41 '' <br />Number of lines - Length of each line Tv - 4 ' Width of trench <br />Type of filter material_ ...d.:A • Depth of filter material 1 9 " Total length----------. 0 e., <br />,.. <br /> <br />... ,.., . o t ... ... .... . ....... <br />e <br />I i <br />1 <br />I <br />. _ <br /> <br />,._..Distance to nearest lot line A • 4 <br />Capac/..9. <br />. . , <br />.4- <br /> <br />No 0 <br />Remodeling and/or repairing (describe): <br />00 a* • fro -450.• • •••• .... . <br />1 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 Loc'al Health District. <br />(Signed) <br />(Plot plan, showing size of lot, location of system in relation ti; wells, buildings: etc., can be placed on reverse side). <br />• FOR DEPARTMENT USE ONLY <br />Address , c 7-- 2- `-/ <br />V 1 <br />/1- ... • . Phone........................... <br />gals <br />A.1#•,—• <br /> lekliPIrlsr9:1/or Contractor) <br />DATE 4 <br />. DATE <br />DATE ...... <br />APPLICATION ACCEPTED BY.. <br />REVIEWEDBY....„,. ................... • .... , ..... , ....... ............. .. .... ..... .. . <br />BUILDING PERMIT ISSUED <br />Alterations and/or recommendationaL....... ... - <br />........ •,•••••• ......... •••••• ..... ...... ••••,•14.•• 04.1••• .. <br />..................... <br />*414••••••. <br />IP... Am, •,.••• ••• •••••••••• <br />... <br />.. <br />... . • .4 ..,•••••••••• <br />WM" 6 1.4 4.11.• .0,• • <br />.. • • • • • ••••••.,•• .••••••••••• •‘. 04,•• ••••••10.• <br />.. . <br />FINAL INSPECTION BY: Date <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> <br />1601 E. Hozollon Ave. Ot3 W Oak Street <br /> 124 Sycamore Street <br /> 205 Virtu 9th Street <br /> <br />5loelaon, California <br /> Lodi, California Manteca. California Tracy, California