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FOR OFFICE USE: - 4 <br /> '- --------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _4Z____/.o <br /> ------------- <br /> ----- -------- ------------- - (Comple+e•in Duplicate) �j <br /> ----------------------------- This Permit Expires 1 Year From Date Is uDate Issued <br /> ed <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 L TION . �' r7 � C7 l I 1. L ( --- - ----------------------—Rwa d------------ <br /> Owner's Name-------•---------'__!_l_C:64:A.Kt>----------M_tLIL_:::1 ------------- ---- --- --- -------------------------- - Phone-•--•---------------------------•--- <br /> Address------------ 1`1 . R :: - � . `---------- ------ ­­------------- <br /> ----------------------- -- <br /> Contractor's Name__0..UiNF_.K--------------------------- ----------------------------------- ------- ---- ---------- ----•---•-------------- Phone------ -•------------..------------ <br /> Installation will serve: Residence® Apartment House E] Commercial E] Trailer loeart Motel ❑ Other ❑ <br /> Number of living units: __�.... Number of bedrooms _�.�.... Number of baths__�.� Lot_size ...ACKEA_6%T------------------------ <br /> I kl%\ <br /> Water Supply: Public sys�tern-E) C.,ogjmm pity system El Private M�Depth to Water Table._,. _ ft <br /> Character of soil to a depth of 3 feet and Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If y `sty,date....._.------------- ) No' New Construction Yes 2r--'No ❑ FHA/VA: Yes ❑ No [ � <br /> ., <br /> ' TYPE OF INSTALLATION AND SPECIFICATIONS: , <br /> —_--�-(No-septic_tank•-or_cesspool.-permitted-if-public-sewer-is-available-wi#hin-200-# t.)- -- - - <br /> Septic Tank: Distance from nearest well__. p....Distance from foundation_. w. <br /> Moate.gal Q C --- t.�" <br /> No: of compartments...__.`....___.._.Size._._ __ : X ..Liqui' depth._./- ----- ------ Capacity- � <br /> Disposal Field: Distance from nearest w 11 _,5P_._.._Distance from foundation--fir-"'--__.----.Distance to nearest lot line---- <br /> Olt, <br /> [ � Number of lines.------------- --------------------Length of each line. /4;04 t_.�_._-Width of,trencl._•_._.`�' __ <br /> vro rf -Tot" s� t r ------- •.. <br /> Type of filter materiaL.._f U --Depth of=filter ma�t�erial----- length_._.-,_.-.f� __. _______________._ <br /> Seepage Pit: Distance to nearest well_____-__._._.-._...Distance from foundation___---_-.-___----_.Distance to nearest lot line----------- ---- <br /> ❑ Number of pits. Lining r saFeti'aL— ------- -- 5iz Diameter-------------------Depth-- -----=----------------------- <br /> Cesspool: Distance from nearest well ___- _ 'D t�n e:gfrcrml.founda'tMn... J. Lining material . --------------------__-- <br /> ❑ Size: Diameter .. ...`.D�r'�t' --- ----- ------------------------- ----Liquid Capacity----------------------------gals. <br /> Privy: D+stance from nearest well............-----...-------.---------------------Distance frAnnearest building------.------------------------------ <br /> ❑ Distance to nearest lot line------. ------------ --------- ------- ------------ ------------------- <br /> 9 and/or d or re air�n (describe): ------------------------__ --------\---------- ----- ----­----------------------------------------- <br /> P g l - f . __ <br /> ----------------------------------------------------- --------------------- 11� <br /> I hereby certify that I have prepared this application and th t'tfte 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 /> ? <br /> )(Sig . .-....-.------ ----------------------Owner and/or Contracto.r. <br /> ned)-------- ------------------- <br /> t _ <br /> -------- <br /> _By:.----- . ------i -------------- . <br /> (Plot plan, showing si'e d. lot. location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE- - (c_ <br /> APPLICATION ACCEPTECD_BY� <br /> REVIEWED BY----- ------- ----- - - ------- -- .--.----------------------------- - DATE <br /> -- ---- ---- -- <br /> BUILDINGPERMIT ISSUED------._ ..._... ------ DATE-------------=----------------------------------------------- <br /> Alterations and/or recomrn <br /> / endattons:- - - <br /> -------------- ------------ --------- - <br /> . � <br /> --------------------------------- - _. - - - <br /> --------------- -------------------- ---------------- - --------------- ------------------------------------- - --------- ------- -------------------------------------------- -------- <br /> --------------------------------- ------ ------ -- ----- --------- -------- '------------- -------------- <br /> f <br /> FINAL INSPECTION BY:------- . _ __.. <br /> ---- ------------,z / 6 ----------- ---- <br /> A I A Ot"TT <br /> 1601 S.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press "• `�" '� <br />