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` FOR ICE <br /> SE: ' ` <br /> t <br /> V_(. APPLICATION FOR SANITATION PERMIT Permif No. <br /> _.. :_ <br /> ------ (Complete in Duplicate) �. Date issued .�/_ --5- �, 3 <br /> "--".-"--"-.----"--""-.----""-----"-"-- -"" This Permit Expires 1 Year From Date Issued <br />' <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 A" , /� <br /> I —�f .. .----•------r� �% <br /> ................. ..........•.......•--------------------------------- <br /> Owner's Name.--------- W ' ------------------------ ------------------ <br /> Address............... <br /> ----------------Address------•-------- 'L 7 ----17------- <br /> Contractor's Name ------- Phone-•-•------•------------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: �/.: Number of bedrooms _-; : Number of baths - ._. Lot size ---------------e _._f!? .......... <br /> Water Supply: Public system [ Community system ❑' Private ❑ Depth to Water,Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑- Clay Loar64 Clay ❑ AdobeHardpan ❑ <br /> Previous Application Made: {If yes,date---------------------I No JC New Construction:es �No ❑ FHA/VA✓✓Yes ❑ Noo <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: w�... <br /> (No septic tank or cesspool permitted if public sewer.is available within'200 feet.) <br />' Septic Tan4:�f(,rij&0ance from nearest <br /> well----- ----- Distance from foundation....................Material........................................ <br /> _...... <br /> 0. of com artments- ---i- a--Size............................- Li uid de th:_----..---_-------------Capacity+ <br /> �a <br /> i Disposal Field: , Distance from nearest well--.S" _-Distance from foundation------ to nearest lot line_.-.j_____..__. <br /> • f.4 <br /> '",r• Number of lines-f--_---_----- Length of each line--------------- `�'----Width of french.-------'4- <br /> Type of,filter material-� ---"--.Depth of filter material------ ----------Total length----.__--_ ..�:... .:....- _ j <br /> Seepage Pit: Distance to nearest well--- ----.--Distance f om foundation.-..- �_-__�.D tante to nearest lot line_ /_4 ----- <br /> Number of pits-----/------------Lining material.49y? ----.Size: Diameter_-Depth-------- �._. ... <br /> 'r Cesspool: Distance from nearest wail.....-r---...-...Distance from foundation--""----------------Lini^g3�material........... --_- :......._-..--.- <br />' ❑ Size: Diameter-------------------------- ----.-Depth-------•------------• -----•-------------•------_--Liquid Capacity <br /> ---------•.............:....gals. <br /> Privy: Distance from nearest well-------¢----------------------------------------Distance from nearest building...._.-.•--_.--.-__.-_-•-.__--.-----.--._. <br /> ❑ Distance to nearest lot line-----------------------------------------------------•-•------•---------•----....------...------•-••--------------------------------------- <br /> � f � " <br /> v Remodeling and/or repairing (describe) p--------- r------------------------------------------------------------------------------y-------.. •------....I............ <br /> { t t <br /> ---•----------------------•----------- t.-.... a <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, <br /> flaws, and rujes andl regulations of the San Joaquin Local Health District. <br />' <br /> (Signed) T /.,.� X.. /w ---------------- ....-(Owner and/or Contractor <br /> i {T'itle� <br /> By: s .... . --------------trifle) <br /> plan, showing s zT a of to ocation o stem in relation to wells,rr�buildings, etc., can be placed on reverse side), <br /> i Vs <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- ---- ..................-------------------- DATE----- ----•----------4 <br /> REVIEWED BY ---•- DATE.-_. -- -- --------- <br /> BUILDING PERMIT ISSUED----__--•-- ---—-------....................---------- DATE-•----------=_------------------ <br /> Alterations and roto en tions:----------r���___ �---G� �------ - -�r-;__�✓4_c-----``"Y` --- ' .._ <br /> 1� z�J <br /> ......................... .... .... � � � ------------------------------------------ <br /> ems+-+_,�t�` �-•� Y^�e,�.0 t �1s�,,.� 'Z.�-/ r--�---U� 7+--c-��"��-. s ��-c.-:.�.�,� �--cZ: <br /> 4 FINAL INSPECTION BY: - <br /> Date-------�.1 —� <br /> --- <br /> ------ --------------- <br /> -.s'v- <br /> �� � S N J A UIN OCAL FLEA. DISTRICTe' <br /> /,,SAN <br /> �Q— — c 4(% - -1: lam— <br /> 130 Souili Amo iean Street 3 W t Oak Street 4 eamo @ 205 <br /> Stockton,California Ca1j o�nEaMew,e�f ori / _ LTracy California <br /> Mt ES 9 REVIrED 6--5tV2M 5-6I ATLAb <br />