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FOR OFFICE USE: <br />------------------ ---- --- ---------- ------------- <br /> APPLICATION FOR SANITATION PERMIT ti Permit No. <br /> (Complete•in Duplicate] fI <br /> ---------------- ---------- --._ ------ Issued <br /> ............................ This Permit Expires I Year From Date Issued Date <br /> Application is hereby,ec e't�o,the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is 7 e in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_----I-L--.0?/------�----- fi 1�®°v `---------------------- - <br /> 1-Pow:-. <br /> ` AJ <br /> Owners Name---- =10. VY -- .: _l _ - Phone <br /> 171 <br /> Address - ----------1-- - <br /> --•----------------------------- <br /> Contractor's Name- } NA�R_ _.. 11! ._ * ----------------------------------- Phone..---- •--------•---••------------• i <br /> Installation will serve: Residence �Appartment-House-[] Commercial E] S Trailer Court ❑ Motel ❑ Other E]s <br /> Number of li i a units- �__- Number of.bedrooms __ ___ Number of baths- Lot size __.�_ - ` .--�-------------- ----- <br /> f owner's Name . <br /> dress Phone <br /> IV <br /> %,naracrer vt son ry avrn'via3 rsarar �a i4a L'J1 v o�c U <br /> I <br /> Previous Application Made: Ilf-;yes,•d� -- <br /> _ - =_f..._._ ) No�ew Construction; Yes No ❑ FHA/VA: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> -� +(No septic tank-�rr cesspool permitted if public sewer is available within 200 feet.) <br /> iii ¢ Pli <br /> riotpf�}_ - _ j <br /> Septic Tater k= Disfance from nearest-well-.=____.D.isiahce)from fou ation____l _ _ _ ._.No of compartments__.__.,- ' Size -' _ �Q_ _ ____Liquid depth._ _ ___"_`. Capacity.-- <br /> ! 1 I oun <br /> Disposal Field: Distance from nearest welt._. __--Distance f{om fdation.__.-__.�..______..Distanc@ to nearest{lot lire_�` _.__.__.. <br /> J <br /> Number of lines--------- —------------------Length;of_each line------ ___._.Width of french '-`2 _•__________ <br /> Type of filter materilL Q. __.Depth of filter material---- --------Iengt�H___..-__--_���_______________ <br /> Seepage Pit: Disfance Tonearest well......................Distance from foundation-._.._____________.Distance to nearest lot line----_-_._____..._ � <br /> ❑ Number of pits--- ------------------Lining material---I---------------- Size: Diameter-----------------------Depth--------------------------------- <br /> n'• <br /> Cesspool: Distance from nearest well _______________Distanae:'�from founda+fan.._._-----_..----..Lining material--------------------.____-_--__.__-__. VV <br /> Size: Diameter- -- --------- - <br /> --- - --M����Deth----'---------------- -----------------------=----Liquid Capacity .-gals. <br /> p <br /> Privy: Distance from nearest well __ ---------------------_---_':...__._..__d.__Distance from nearest building.___._..______________---__..____._____.. <br /> €! <br /> Distance to nearest lot line-=------------------------------_. ' <br /> Remodeling and/or repairing (describe):.............°.___-_______ -_ -._ I <br /> ----- -----------------------°--------•--------------------••------- ------------------ -------------------•--•---- <br /> 5 ` <br /> __________________________________________________________ -----------.__.------------------------------------------------------------___________..___._-_.___._____- -------------------- <br /> t <br /> • I -------------------------------------------------------- ____________________________ <br /> I hereby certify that I have prepared this-application anal=That the 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 /> Si ned tom` ' -- �� `-.. (Owner and/or Contractor) <br /> { ] --- -- <br /> g <br /> - ---: -�:_.-.{Title].-=-- ^- <br /> (Plot plan, showing size of lot, location of systemiin relation to wells, buildings, etc., can be placed on reverse side). <br /> 'POR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__7771i-1?.—---------------------- ------, ---------------------- ------ DATE---- I _ ----•------ <br /> REVIEWED BY------------------------_- -- ------------ ---------------------------------- }' ------------------ DATE------------------------------------- <br /> ------------------ <br /> BUILDINGPERMIT ISSUED-------- -- ------ ------------------------------ -----------•------------------------------ -------- DATE----- -------------------------------------- --------------- <br /> Alterations and/or recommendations:.--------- --- --- ------------------------------------------------------------•------ ------ ----------•- --- - <br /> -------------------- ------------- ------ ------------------ --------- -------------------- _ ------------------------------------- ---------------------------------- <br /> -------------------- <br /> ---------------------------------------------•---• -----•----------------- - -__ _ --------- --------•-------------------------------- -------------- ------ ---- <br /> I ------------- --------- -------------------------- ---- --------------------------- ----------------•---------------------------------=------------------------ ------ --------------------------------- <br /> i -------------- - -- - <br /> i <br /> FINAL INSPECTION B . , . Date------------- -r_f_ -il ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 west oak street 124 Sycamore Street 205 West 9th Street <br /> i 5toekton,`California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />