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FOR OFFICE USE: �0 �� :5 'S L4 e*s " Y-0�aL70 /5 <br /> ----------- -------------------------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. ----------------- <br /> ..........I---- -------------- -------------------------- (Complete in Duplicate) Date Issued 75 <br /> - <br /> --------------------------------------------------- -------- <br /> --- <br /> k_----- -- This Permit Expires 1 Year From Date Issued I <br /> I ' <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 Ordinancp No. 549. <br /> yI <br /> h )fu' <br /> L , -------------------- <br /> JOB ADDRESS AND LOCATION.._O_V&Iek�--k-4_M___6 ---------- - ------- <br /> Owner's Name --- -- ------------------- - --------- --------------------------------- ---- Phone---------------------------I-------- <br /> aA4_415-4. ------------------------------------- C) <br /> Address--------1------ <br /> ----------------------------------------------------------------------------------------------------------- <br /> _ ------------- <br /> Contractor's Name-__ ---ede.-4- --------------­--------------------I------------------------------------------ ---------------------------------------- Phone----------------------------------- <br /> otel 0 Other [3 <br /> Installation will serve: Residl9ce 09-"Aparfirrient House 0 Commercial E] Trailer Court ❑ M <br /> Number of living units t Number of bedrooms Y� Number of baths.-I/- Lot size !--------•--------------------------------- <br /> Water Supply: Public system El Community system [I Private C& Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [-] Sandy Loam E] Clay Loam [3 Clayb Adobe [] Hardpan 0 <br /> FHA/VA: Yes E] No P9- - <br /> Previous Application Made: (if yes,date-- ------------ No INew Construction: Yes No E]V <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-/Z CO4-Distance from foundation------ <br /> - - ---------- -------------M,ter�il--- -------------- <br /> Size_$/A/j2_A__5-------•---Liquid depth-------/——--------C,p,City__/_2,_0__P------- <br /> No. of compartments-------;�------- ------- <br /> Disposal Field: Disfance;from nearest well from foundatlon.�_2-V----------Distance to nearest lot line.A;? P__ <br /> _/--- I -----------------ch .1f <br /> ---- <br /> Type <br /> of lines-------��Z-------------------------:Length of each'Ilne-----7-6-------- ----Width of tren <br /> material___ _.- _/-------- <br /> Type of filter m T' Depth of filter material----9_4�/---Total length-------1_5 <br /> Seepage Pit: Distance to nearest well------ ---------_1---Distance from foundation--------------------Distance to nearest lot line <br /> Number of pits----------------------Lining material------------------ ----Size: Diameter------------I-----------Dep6-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from fo'undati6h--------------------- Lining material_____________________________________ <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter--- ------------------Depth_---- ­--Liquid Capacity_--------------------------gals. <br /> ----------------------- 77= <br /> PrivDi�sf­nce from.nearest well______. ____. -------5D5,Distance from_f2m-�-1n-earest--b u-ti- <br /> l�n ------- <br /> - ------7=________- ----- - <br /> Z <br /> y. <br /> ----------------------------------------------------------------------------- <br /> ❑ Disfance.to nearest lot line-------- ----------------- -------------------------------------- <br /> Remodeling and/of repairing idescribe):------------------------------------------------------------------------------ --•---------• --•------••-•------------------------------------- <br /> --------------------------------------------•----------•---------------•---------------•------------------------------------------------------------------- ­---------- --------------------------------------- <br /> ------------------------------------------------------------------ <br /> ------------I—--------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------- ------ - --- <br /> -----------------------------------------------------I-------------------------------- ------------------------------------------------------ --------- <br /> I hereby certify that I have prepared this as <br /> and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, aqd rules and r la+*Lons of h San Joaquin Local Health Disfricf. <br /> T, 7 11-10 ._(Owner and/or Contractor) <br /> (Signed) X41-1 --------------------------------- --------7------------------ <br /> ----------------------I--------- ------------------------------ <br /> By:------------T_1--------------------------------------------------------------­- <br /> ---------------------------------------------{Title]----- ----------------------- ----- - -- ------------- -- -- <br /> (Plot plan, showing size of lotjocation of system.in.relation.to wells. buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ----------- --------------------- <br /> --- --- <br /> D�DATE <br /> -- <br /> REVIEWEDBY--------------------------- ------------------------------ - ------ -------- --- TE <br /> BUILDING PERMIT ISSUED----------------- ------- - <br /> ------------------------------------------------------------------------I------------------------- ---1------------------- <br /> - <br /> - <br /> ---- ATE----------------------- <br /> - <br /> Alterations and/or recommendations: ---------------------------------------------------------------- ---------------------------------4----------------------------------- <br /> I <br /> ---------------------------------------------------------------------------- ---------------------------------------------I----------------------------------------------------------------------------I---------- <br /> -------------------------- --------------- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------- --------------- <br /> --------------------------------------------------------------------- <br /> ------------------------- ---- --- ----------T---------------------- ------------- --------------------- <br /> a <br /> ---------------------------------------- -------------- ------------------------------------------------------ --------- <br /> --------- ---------------------------- ------------------------- ------- <br /> FINAL INSPECTION BY:..- -------- Date------------- ----------------------- <br /> --- ------------ ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> VS 9 REVISED 6-59 31A 3­621 F,P-CO. <br /> -ar;lb-1 - <br />