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FOR OFFICE USE: <br /> ze� Permit No. <br /> ­--­------- ---------- -------- -_T <br /> APPLICATION FOR SANITATION PERMIT <br /> - ---- -------------------------­------- .......... <br />----------------------------------------------- ­. (Comple+e-in Duplicate) Date Issued <br />--- --- ---- - - ----- ---------------------------- This Permit Expires 1 YeJ� Fro�n Date Issued <br /> I, <br /> Application is hereby made to the San Joaquin Local Health Disfridl,for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 5 1 49. <br /> JOB ADDRESS AND LOCATION------- _&----------- 11,lctx, ---------------------------------------------------------- ---------- <br /> Owner's Name__._,_ZV_W_ t= :'bb <br /> -- ------ ------ - --- - ---------- ------ -------- Phorieg <br /> Add ------ ....ca......:------ -- ------------------------------------------------------------__---------------------------------- ------ <br /> Contractor's --------------------------- -------------------------1-__:,1--- ------- -------- -------------------- ---------- ....� Phone------ -------------------------- <br /> Installation will serve: Residence E] Apartment House E] Com �11 rcial R Trailer Court El Motel 0 Other [I <br /> Mill" f I <br /> Number of living units: -- ----- Number of bedrooms ........ Nu.m�er of baths -------- Lot size ------------- ------------- <br /> Water Supply: Public system 54 Community system [I Private h Depth to Water- Table ------ - ff <br /> Character of soil to a depth of 3 feet- Sando Gravel El Sandy. Loam E] Clay Loam E] Clay 0 Adobe E] Hardpan 0 <br /> Previous Application Made: (If yes,date------------------� ] NojZ NewConsfrucf;on: Yes % NoE] FHA/VA: Yes El No.K <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1111 57/ - <br /> Septic Tank Distance from nearest we�/5M---- Distance from foundation-- /! ------Material ---Q__ <br /> Hi T <br /> '19 No. of compartments---------Z............. -- -- -------Liquid clep�h------ Capacjty__?P_0--------- 'NQ <br /> 11 <br /> Disposal Field: Distance from nearest Distance from fcundafion__,V:4F_4.....Distance to nearest lot line.74�.. ..... <br /> Number of,iines -------- r__, --Width of french.... 2,5Z 'r <br /> J --------Length of 111a, ch line---------Z/O- - -- - --------------------- <br /> Type of filter mafi _-Depth of fi'4er material---- ..........Total Iengfh__fK_0------------------------ <br /> e <br /> 0 lza <br /> Seepage Pit: Distance to nearest well-117k�;kIr Distance fripm founclaflon___04�-------DistanceJo,nearest lot line <br /> Number of pits._/---------- Lining aferial---- Size: Diamefer___3_5.��....t!'Depfh___.2._,57-------------------- <br /> r <br /> Cesspool: Distance from nearest well ----------------Distance from foundation ----- ..,Linlng material----------------------- ------------- <br /> - i .d <br /> E] S�ze: Diameter. _. --------- ----- -------- Depth------ ...... ------------------- -------��---"'_Lqu( Capacity----------- ------ --------- <br /> Privy: Distance from nearest well------------------------------------ - ------- -Dist... rorn nearest building----------------------- ------ ....... <br /> El Distance to nearest lot �ire-- ---------- ------------- ......4---------------------�>,--------------------------------------------- - - ----------- <br /> J. <br /> - ----------- <br /> Remodeling and/or p.pairing (clescribe):�*_ ------ -----� <br /> ----------------------------- ----- <br /> -----�_:7t ev,_1- ----- ---------,-/ <br /> ...............7��.. ...... <br /> ---- ----------------------------------------------------------------------- -----------­-------- -------------------------------------- -------------------------------------------------------------------------- <br /> . ;I P <br /> -- ----------------- ------------------------------------------­-------------------------------- ------------------------------------------------ ----------------------------------------------------- <br /> I hereby certify that I have prepared this application and that fhe.work.will be done in accordance.with San.Joaquin County <br /> . ­ .. - - -_ -I"Lo <br /> ordina&C-6—s, Sfa fir "d rules al-r I <br /> ? -ru ations of the San joa4uin cal Health District. <br /> . .. .... ...................... 'torl <br /> ........ -- --------------- - ---------------------- (Owner and/or Contrac <br /> (Signed)-- <br /> By:-------------------------------- -------------------------:-------- --------------------- ------------------------------------ (Title) �---- - ---------- --_----- - ---- ........... <br /> (Plot plan, showing size of lot, location of system in relation to wells].buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMEN't USE ONLY <br /> ----------------- <br /> APPLICATION ACCEPTED BY_4e _�4_ ... ... -------------------- --------- --- ---- ----- DATE <br /> REVIEWED BY-�:?_- ------ ------.......... ----------- --------- -----------...--DATE-----------------------------------/ <br /> ------------------------ ------------------------ <br /> BUILDING PERMIT ISSUED-------- -- --t----------------------------I L------- --------- --------------------------------- DATE------------ ------------------------- <br /> Alterations and/or recomrneni:�,fj;_O­ns!� <br /> ..........i-------------------- --------------- ----------------I---------------------- ----------------4---------------------------------- <br /> ............ ......................... ------------f_L� --- ------- i------------ ------------------ ---------------I------------ ----- ------------------ ----------- <br /> ----------­.­- ------------------- -----------I------------------------ ---------------------- -------- ----------------------------------------------------------------- ------_-------- <br /> ----------------- ................... ----------------.. ...........i:------ ...... ------------- ----- --------- ------------------------- ............ <br /> ....................... --------- ......... --­-------------- - ---------- --- ---------- ------------ ....... --------------------------------------------- <br /> F <br /> Dat -7............................................. <br /> FINAL INSPECTION BYO. e-e��e---- A I------- --------------------- <br /> - --------------- <br /> 311-11707 <br /> C&PY J�r (Tte"t- SAN JOAQGINI:LdCAL�H-EALTHDISTIR-ICT, <br /> 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.K.9 2M 1-67 Vanguard Press <br />