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FOR OFFICE-USEr <br />A- <br />-------------- --------- --------------------------- <br />.. ­ ................ .. ................. --- ------ APPLICATION FOR SANITATION PI:DkAIT Per-;+ No 3 3<- <br />- ------------ <br />------------------ ---------------- ------- (Cornple+e,in Duplicate} Date Issued <br />--------------- -- -------------- -------------- This Permit Expires I Year From Date Issued <br />Application is hereby made to the Stan Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliah,be with County Ordinance No. 549. <br />1 <br />- )4 <br />ll <br />JOB ADDRESS AN LOCATION. ........... <br />............ R.wo[V ------- Rt -- ---------------------------- F-3--f-i <br />Owner's Name ---------- 0. I -z- At ------ Duu-_r --- ------- MRMPhone------------------------------------ <br />Add- <br />% -- ----- F._ -k- _S --------- ------------- ress --------------------- ------------- 66 <br />----------- --- ------------------------------------------------- ------------------------------- <br />Contractor's Name- -------------------------- -------- Phone------ ----------------------------- <br />Installation will serve: Residence Ej Apartment House.[] Commercial E] Trailer Court E] Motel El Other E] <br />Number of living units: A_____ Number of bedrooms Number of bafks"C_ Lot size — -------------------- <br />Wafer Supply Public system El Community system E-] Private � Depth to Wafer Table ft <br />nd.­ <br />Character of S'011 to a depth of 3 feelf- SandE3��Gra arcy:Loam_,8�Chiy Loam[:] Clay[] AdobeE] Hardpan[ - <br />Previous Application Made:, (If yes, date:.-- New Construct ion FHA/VA.. Yes ❑ -No. <br />TYPE OF INSTAL AT] <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: L Distance from nearesf__,well ....... --------- Distance from foundation ------------- ------ Material - ---------------------------------------------- <br />�:N'O?,-G(f�,c-bm-p6rtm,enfs--�i ------- 1 -------- _..Size-------------=---- - -----------Liquid depth------ ... ........ Ca <br />; I - -, --------CapacitySof Dis osal Field: I Distance from nearest 11.. S -4Z ----- Distance from foundafion foundation___ `______________Distance I ---------- Distance to nearest lot line_S --- <br />f3USTJ f4&� Number of lines.--------- I :� <br />--- ------- ------ Length of each fine--.-- ------- Width 6f,trench._-'___.,_2Y ------ ------------- <br />Type of filter ma�erial._&O` r�,_.__Depth of filter maferial ...... (--'7 ------- -- Total length___..__ <br />--------------- <br />_� <br />Seepage Pit:;Distance o <br />- nearest�Iwell -------- ------------ Distance from foundation --------- : ---------- Disfance to ne&eO lot line____..______..._ <br />F-1 Number of pits ---1---------- , --- ---- Lining material----------- --------- Size: Diameter.-------------- _:--- Dept I h ---------- ----------- <br />Cesspool: Distance f�'or� n I <br />earest well -, -- ---------- Distance from foundation----------------- .1ining material----------------- .... <br />I -_ -_ -_ - .--------------- <br />Cess <br />--- ---------- <br />F11 Size: Diameter- A --------- ----- ------------ ---De pth ---------------- ------------------ - - - ---------- Liquid Capacity---. ----------- <br />-31 Q1 Dibuilding-______.____,_._____.____ <br />------------- gals. <br />Privy: Distance from nearest well________________ <br />---- ----------- -------------- isfance fro'rn nearest building ---------- __ --------------- ----------- <br />El Distance to nearest lot line_________________"".--_ ,'A I -i � -, I <br />------------- ---------------- ----------------------------------------------- -------------- <br />Remodeling and/or repairing'.' (cle'scribe): --------------- i ---------------- ...... ------- ------------------------------- <br />-------------- <br />------------•------------•----- ------------------------- - --- ----_------------- ------------------------------------------------------------------------------------------------------- ------------ <br />-------------------------------- ----------------- I ------------------- <br />- --------------------------------------------- ---------------------------- <br />--- --------------------------------- ............ -------------------------------------------------------------------------------------------------------- ------------------------------------------ -- <br />I here6y certify that I hA-ye prepared this applicafion.-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 L�oca Health District, <br />---- --------- <br />S�jgned) ----------- .. ....... ------- 52& S ----------- <br />...... . ..... <br />...{Owner' and/or Contractor} <br />By: --------------- .... . - ----- ---------------------- -- -------------------- 0 ifle) <br />� <br />(Plot plan, showing 1 do of lot;_location 0 syste. in relation ­t6VAlg;buildings, etc., can be'placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED <br />---------- DATE___,� ---- <br />REVIEWEDBY -------------------------------- ­_- ----- I --------- ----­----­---- ­­- -------_------- ........ DATE-----':.------------. <br />BUILDING PERMIT ISSUED-------- -- ----- --------_-_----- ---­------------- -------------------------------- \ ----- DA-TE----- <br />Alterations <br />ATE-----Alterations and/or recornrnendaf ions. ....... <br />- ----------- -- ----------------------- - -------- % ----------- -------------- ----------- - <br />----- ---- <br />V <br />-------------------- ----------------- ------------------------------- ............ <br />-- - -- ---------------- ----------- <br />v ­�­ -------- ------------------------------- -------------- <br />---------- -- <br />-------- ------- ------- ---------------------- <br />_1:�____.____-_-_"­_'_, ------ --------- -­ ------ ----------------a:: ------------------.7 � - - - - - - - - - - - - - - - - --- - - - - - - - <br />- - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - .. <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --------- <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -•- - - - - - - - - - - - - - - - - - - - - <br />------•- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --------'-------------- <br />FINAL <br />------I--------------FINAL INSPE&IGN_ 7"o <br />��/w Date ........ <br />BY—. - <br />I" , --- I ­ ------------------ --------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazellon Ave. 300 West Oak Street 124 Sycamore Street <br />205 West 9th Street <br />Stockton, Calffornia Lodi, California Manteca, California Tracy, California <br />E.H. 9 2M 1-67 Vanguard Press <br />