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,vrt vrriUe UZ)C: 3juo ^� <br /> --------------------- <br /> - ----------- ------------------------------------------- APPLICATION, FOR SANITATION PERMIT Permit No. <br /> -` (Complete in Duplicate) <br /> f-SgE,.cuST-= ^i ' "' Date Issued <br /> =Q--,,..._ This Permit Ex ires 1 Year From Date Issued <br /> 1 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 comp)"ante with County Ordinance No. 549- 2 2� 17V-Z8 <br /> I <br /> JOB ADDRESS AND LOCAT u <br /> Owner's Name_____. <br /> • W R_4_P" -- -------R D / C n� [C�HLA D <br /> -•--------------���-----------���----- ---��K--' ------------- - -------------------------------------------- Phone------------------------------------ <br /> .3 <br /> - ---------------------------••---- <br /> �j <br /> Address xt_-_----------Y] pp 1J---t--------------------•---------------------------------------------- <br /> Contractor's Name_________-4N_T _0tJ ____ ------ /�"S - r <br /> --------------------------------------------- ------------------ Phone <br /> Installation will serve: Residence <br /> B' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -___ Number of bedrooms _f 2/ • <br /> - Number of baths ____ _z-•Let size ___"-.___--_"_-_____-_._ <br /> Water Supply: Public system ❑ Community system ❑ Private s Depth to Water Table /9-' ff. <br /> i <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ . Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date__________________"J No <br /> t New Construction: Yes [�No ❑ FHA/VA: Yes R' No ❑ r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ""--*"`—(No septic tank or cesspool permittecUf public sewer is available within 200-feet:)` <br /> Septic nk: Distance from nearest we I___5 -----Distance from foundation__A2---------.Mat <br /> No. of <br /> �- compartments--------1- ---------------- Size___,xfflX,57---Liquid depth------I �- ------Capacity. / PF <br /> Disposal Field: Distance from neast - -Distance from foWdation____/Q_--_"__-Distance to nearest lot line----`� _ . ;``lNumber of lines-- ----------------------------Length of each If?-7S <br /> 457Width of trench---------3±6-!� <br /> Type of filter mate rialR(QGK-----Depth of filter material....IF------------Total length---_________22 <br /> s <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------_Distance to nearest lot line----------------- <br /> 1771 Number of pits---I-------------------Lining material---------------------- Size: Diameter-------=----- --------Depth------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation____--------------- Lining material-----_____----__--_--__"____-____- V+ <br /> ❑ Size: Diameter--- i-------------------- ----------Dep#h------------- ---------------- ---------------------Liquid Capacity.- -------------I----------gals. <br /> ` I <br /> Privy: Distance from nearest well------------------------------------------ ----"Distance from nearest building---------------------------------- <br /> -- <br /> ❑ Distance to nearest lot line__: <br /> Remodeling and/or repairing (describe):-----lA/10 <br /> L <br /> ----N(t-T---'I-NSTH�-[� j�----AT---7]M ---- 3 ----JNSYC�_ :--------- 3 <br /> --------------•- <br /> ------------------------------------------------------------------------------------------ -- <br /> ------------------------------------- ------------------ -- ------------------------ <br /> ------------------------ ----------- ------------------------- -------------------------------------------------------------------------------------------------------------------------------- ---------------- ---------: 1 <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, and rules andreguiations of the San Joaquin Local Health District. <br /> (Signed]---------- -------------- - ---------- -.-__-(Owner and/or Contractor) <br /> -. Plot plan, showing size of lot, location s in relation to wells, buiidin s, etc., ca Title1­1 , <br /> ( P g - �,,,- . - . _ .. <br /> g n be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------75KO------- ----------------- ------------------- DATE_ - 1 �+ �a- <br /> REVIEWED BY--- ---------------------------------- <br /> ' --- - <br /> DATE----- ---------- --------------•----- <br /> BUILDING PERMIT ISSUED ------------------------------- -------- DATE----------- <br /> ------------------------- <br /> Alterations and/or recommendations:_1--- ------- --------------"------------------ <br /> ---------------------- ----------------•--------------------------------------------------------------------- <br /> --------------- ----------------------------•-- =------------------------------ <br /> - ----------------- <br /> --------------------------- ----- s <br /> ------------- <br /> ----------------------------------------------- - - - <br /> FINAL INSP TION -- __ q GG <br /> bate --------•_/.- / �. F _`--------------- ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th StretSP"�" <br /> Stockton,California Lodi,California Monleco,California Tracy,California <br /> F.P-CQ. �' <br />