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I-UK Ul-FICE USE: �_ I <br /> 4 ,t Aa <br /> ---- <br /> ------------ -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .... ---- <br /> - -- <br /> - ----------------- ------------- ---------------- -------- (Complete in Duplicate) <br /> --- ----------------------------- This Permit Expires I Year From Date Issued Date Issued ... <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 incompliance with County Ordinance No. S49, E-750)LOA." <br /> JOB ADDRESS AND LOCATION..L_4,0.o6-_q,----- <br /> Owner's Name-------- <br /> _jq <br /> Address......... ---------------------------------------------- --------------------- Phone.. -------------------- <br /> Rna_ ....... ........4�� <br /> I Contractor's Name_____.-; MIWLA_/ <br /> ------------ Phone........... <br /> --------------------­-- <br /> Installation will serve: Residence Apartment House E] Commercial El Trailer Court 0 Motel 0 Other <br /> ❑ <br /> Number of living units: J---- Number of bedrooms -3 Number of baths ... Lott size ----------�-- <br /> Wafer Supply: Public system [I Community system E) Private [Z] Dep+h TO Water 3 <br /> ble -F.-ft. <br /> Character of soil to a depth of 3 feet: Sand --- ..r ............... <br /> Gravel [] Sandy Loam 0' Clay Loam [] Clay [I Adobe 0 Hardpan 0 46 <br /> ----- <br /> Previous Application <br /> cation Made: (if yes,date-------------------- No E2"' New Construction. Yes ®"'No El FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> -(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> rorn nearest well-------------- Di0ar from foundation ------- F <br /> Sep?641- istanceM.7 - — f> <br /> compartments_______ _------__--Size__ <br /> i <br /> No. of menfs--------Z — J8 <br /> 1- XICA-.5 ---Liquid clep�th__ -------------------Capacify../:9!��--- <br /> Disposal '61d: Distance from nearest well._��----Dilfance from foundation._•__/ --------- istance to nearest lot line....`___._.... <br /> ............ <br /> Fiel, Number of lines---------0--- ----------------Length of each line-,-----�50­_-----------Width of trench.-----�2_y <br /> -16 -.__Depth of filter maferia <br /> Type of filter material,J77 ------- .....Total length <br /> ------------------- <br /> Seepage Pit: Distance to nearest well------------_--------Distance.,,from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits '1,.__._._.__,_Q7_____Lini matJ'rial--—----------------- Size: Diameter - .1 , <br /> _qg -.--..Dbpth----------1--- <br /> fj I I---------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation___._.____.___._--- Lining material--------------­- I- -, <br /> El Size: Diameter--------------------------------------Depth--------' -------------- ------------------- <br /> Privy: Distance from nearest well__________ _____ I --------------------------_-Liquid Ca pacify-. ------gals. <br /> ------j------------------ -------Distance from nearest building ........ ------------ <br /> Distance to nearest ]of line <br /> Remodeling and/or repairing (describe]:_________________________ <br />' -----•- <br /> -----•------•--- <br /> describe)--------------- ------------------ -----------------------------------------------------------­-------- <br /> ------------ -----------I­---------------------------------------------------I------------- _'4� ---------*----------------------------------------------------*---------*------------------•----..------------------ <br /> ---------------------------------- ------------------------------------ ---------------------- -------- - <br /> ------------------------------------------------- ----..•-------'------ --------_-- -------------- -------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the 'ork will be done in accordance with San Joaquin"'C'c'u'n---- <br /> %y <br /> I ordinancei, State laws, and.'rules. and regulations of the-San Joaquin Local Health District. ty <br /> N14 r"4,A :to Lz <br /> (Signed <br /> ---------------- <br /> -----------------------------------------------------------------(Owner and/or ontractor) <br /> By:------------------ <br /> (Plot plan, show;,n ixe a ----------*--------------- <br /> - ­-------------- ----------- -----------------* -----------k------------------------(Title)----------------------------------------- ------- ---- - ------- <br /> Ize Of lot, location of system in relation wells„buildings,Idings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY,------- -------------------------- --------------------------------------- DATE---______ .• _• 1D- �� <br /> REVIEWEDBY------------------------- ----------------------------------------- ----------- ---- ------------------------------ DATE------- --------------------------------- - <br /> BUILDING PERMIT ISSUED ------------ -------------------------------------------- <br /> ------------------------------------------- _------------------- DATE..... <br /> or recom en - ------------ --------------------I----------------------I------ <br /> Alter;fi ns —nd/---m-dafions- <br /> 4ri------------------------------------------------------------------------------------------------------------------------------•-•-----------------­---------------------------•---------- <br /> - <br /> ------------------------ -------9----------------4 A 2N <br /> -----------I----------------------------------------------- <br /> .......................................... ----------- ------------------------------------------------------*----------------------11---------------------------------------------I-------------- <br /> --- -------------------- ----------------------------------------------------------------- ----------­-------------- <br /> ----------- <br /> ........................................... ---- -- 11 <br /> - - ------------------ - - - ----- ------ ------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTIO <br /> Date---- ----------77-7.42- ---- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street <br /> Stockton,CaliforniaLodi,California 205 Well 9th Street <br /> Manteca,California Tracy,California' <br /> ES 9 REVISED B.59 2M 5.62 ATLAS <br />