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FOR OFF CE USE: <br /> A <br /> '? <br /> ................... . APPLICATION FOR SANITATION PERMIT Permit No. <br /> ......................................•--•••. -•---••--• (Complete In Duplicate) <br /> ............... ......... ......... ....... This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-._-�/ZOd....... -------- ..................................................................................... <br /> Owner's Name...ZWW&A,.........4W. .2/_,Se)xV..................................................................................... <br /> Address..._............... .................................................................................................................................................................. <br /> Contractor's Name............ ..TVwp..................................... Phone. ... ...4R.A.......... <br /> Installation will serve: Residence � Apartment House [-] Commercial [j Trailer Court [] Motel [I Other [I <br /> Number of living units: .../.... Number of bedrooms Number of baths I.... Lot size ......................... <br /> Water Supply. Public system eCommunity system 0 Private F <br /> IV Depth to Water Table 3 ft. <br /> Character of soil to a'depth of 3 feet: Sand 0 Gravel [] Sandy Loam E) Clay Loam [I Clay C] Adobe&K Hardpan El <br /> Previous Application Made: jif yes,date.......... .........) No e New Construction: Yes E] No Rr FHA/VA, Yes C1 No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance from foundation---------------....Material................................................. <br /> ❑ &fS1_1AQ No. of compartments...... ...................Size................................Liquid deoll..........................Capacity....................... <br /> Disposal Field; Distance from nearest well.................Distance from foundation....................Distance to nearest lot line................. <br /> Number of lines...................................Length of each line..............................Width of trench......._......_._......_..... <br /> Type of filter material.........................Depth of filter material.......................Total length.......................................... <br /> Seepage Pit- Distance to nearest weIl..A4V0JV4F...D'is,tance from foundation...14147!.......Distance to nearest lot line-..%? ....... <br /> 4W XWS77Ai6 Number of pits......../...........Lining material..;P10.0-A.......Size: Diameter..... Depth........ ..........I...... <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material................................_..._ <br /> 13 Size: Diameter......................................Depth...................................................Liquid Capacity............................ga15. <br /> Privy: Distance from nearest well........................................ .......Distance from nearest building...........--........._._...._............ <br /> ❑ Distance to nearest lot line............................................................................................................................................ <br /> 4 <br /> Remodeling and/or repairing ...... .itPx...... 15-T.----60 <br /> 2.................. <br /> ............................................................................................................................................................................................................... <br /> .....................................................................................................................................I..................................................................................... .. <br /> ............................................................................................................................................................................................................................ <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 /> (Signed)............ 9eV0oeVX...,. i.............................................................(Owner and/or Contractorl <br /> By:............A!270x .......4:.2�. _ - _ ............................................................(rifle).........4.14-1-04"......................................... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 69 placed an reverse side). <br /> FORFPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..... .0..... ............ ----------------------------------- DATE...I.A..-.:rU.:7" 2 <br /> "• -,O—L-a---�i .." ... <br /> REVIEWEDBY.......................................... . .............................................................................. DATE............. <br /> BUILDING PERMIT ISSUED......... i�/ <br /> ...............................-----•---•----•-•-............--••--•-•-••-•-•-•. DATE........................................................ <br /> Alterations and/or recom;nendations:.... ........ :.... ........ ... ...................... <br /> ....................e. <br /> .................................................. .................................................;............................... ..........................................it.......................... <br /> . . ........ <br /> ......................................................—......I............._............ ........ ........................................................................... ........... ..................... <br /> ............................................ ...................... .................................................................................................................................................... <br /> FINAL INSPECTION BY:.. Date.14-.4, --.6----Z...................._­---------- <br /> I---------- ---- - -------- .... ........ .. ...... <br /> SAN JOLOCAL HEALTH EALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strom <br /> Stockton,California Lodi,California Manteca,callfornle Tracy,Collfornia <br /> 95 9 RCY1690 8-b9 91A 6-01 ATLAS <br />