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ae r <br />(7AjPLICATIWF05R% SANITATION PERMIT 4 Permit No. <br />(Complete in Duplicate) <br />D6te 1 ssu <br />I - ed ------ <br />Application is hereby -made to She San.Joaquin Local Health District for 'a permit tQ construct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. 1? -2_1(0-1q <br />_tr -A <br />JOB ADDRESS A0 ATIN-0-.0-OX- ------------------------------- <br />Phone --7- ------------------ <br />------------------------------------ ------- ------- <br />Owner's Name___'_r_1 --------- ....... P <br />Address ---- ----------1 ---------------------------------------- -------------------------------=---------------­-------------------------------------------------- ------- --------- <br />Contractor's Name------------------------------------------------------------------ Phon ------ <br />7_1 <br />Installation will serve: Re7sij 7ce W­t�`Apartment House El (fommerci;I'M Trailer Court El Motel E] 'Ofker ❑ <br />4 C <br />Number of living units; J- -Number of bedroomA_?.. Number of baths __/_ Lo t, size ----------------•---____-- <br />Water <br />--------------- --------- <br />Wafer Supply: Public! system'E1_`C`ommu6ity system E] private 0 Depth to Water Table w1_Jft. <br />Character of soil to a'ldepth of 3 feet: SandE] Gravel[] Sandy Loam 9,1 --clay Loarh E] Clay[] Acloben HardpanE] <br />Previous Application Made: Yes El -No PR'—New-.Construction-?-Y-es-B-No �FHA/VA: Yes El No El A <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic fankorcesspooI' �rmiffed.if_pu6lic sewer,isavailable within,200 fee+.) <br />.ip( <br />ti <br />ank: Distance from nearest well -__--_--------_-Distance from foundation -------------- I ------ Material - ------------- ----------------------------------- <br />No -of compartments ---------------"v ....... S-i':e ------------- - I <br />----------------Liquid depth----------------------- ---Capacity- - *-------------- i ------ <br />A <br />Disposal field: Distance from nearest <br />wells ..-Distance from foundation -j ------ - <br />---- Distance to nearest lot line --- ------I-- <br />Number of iin I'll ------- / -- -----M4 Depth of filter material--_ J -----Total length <br />Length of each line--)--------_. Width of trench ------ 4; _!P11 ------------------- <br />I.Ty�e of filter material__------- 2;;FP_ 7. ------------------ --- R <br />Distance,-6pm --------- Distance to - -- --------- <br />Seepagg,pit: Distance to nearest fFunclation-Z-a- nearest lot line i S77 <br />1 <br />Number of pits ____/ -------------- Lining material:--' Size: Diameters Depth ----- CI?17 ------------------- <br />Cess'ool: Distance fromLearesf well- ---------------- r -Distance from foundation--_-------- - Lining material--.-------------.._.-_--._- Z7� <br />p j - - 4 <br />F-1 ISize-. Diameter.: -------------------------------------Depth------------------------ 1----- ------------- L_Uquid Capacity------------------ .... gals. <br />09 <br />Privy: Distance from ,nearest well -------- I <br />--- ---- -----------------:_--;--Distance from nearest building-.-. -------------------------------------- VQ <br />El DiStapce 'To nearest -lot. line:—: - ---------- -------------------------- ------------------ ------------------ : -------------------- -------------------------------- <br />T + <br />Remodeling and/or, repairing {describe):--------------------------------------------------------- ------------ I --------------------------------------------------------- <br />• <br />---------------------------------------- -------------------------------------- * ------------ -1 ------- --------------- ---- -- <br />---------------------------- ------------------------------ ------------------------------------------------------------------- -------------------------------------------------- <br />-------------- ------------------------------------ -------- <br />ZI - 7- 0 <br />A._ ------------- I -------------- I ---------------------- I ---------------- <br />--- -- ---------- -- ----------------------------------------------- _ ---------------------------------------------------------------------------------- <br />I hereby certify that I hav prepared this application and that the work will be done'lin accordance with San Joaquin County <br />ordinances, d e and .n )f,t"an-Jos quin Local Health District. <br />tions c <br />(Sig-ir <br />------- ------- (Owner and/or Contractor) <br />..... --------- - -------------------- -------------- <br />--------------- I - ------- -------- <br />B ------ r ------------------------------------------- <br />[PIJ plan, showing SiZ4 of lot, location of system in rTion to wells, buildings, etc., canl6e placed on reverse side). <br />ES -9-2M - Rev;se6 1-57 F.P.00. <br />FOR'DEPARTME NT USE ONLY <br />APPLICATION ACCEPTED BY ---------- - <br />---------------------- ---------- 6ATE -------- <br />----- ---------------- -- <br />REVIEWEDBY --------- 1-1- ---------------------------------- <br />------------------------------------- ------------------------------------ DATE ------------ <br />-------------------------------- ---------------- <br />BUILDING PERMIT ISSUED ------------- <br />---------- <br />- 'N V [DXTE ------------------------------------------------------------- <br />-------------------------------------j ................. ....... <br />Alterations and/or recommendations:-- ------ <br />------------------------ ---- -------------------------- ---------------------------------------------------- <br />I -_ <br />----------------- <br />If. I <br />, I ---------------- -------------- <br />---------------------------------- ------------- <br />------------------------- I ---------- m ---------------------------------------------------------------------- <br />s'A i!n <br />--------------------------------- ----- - ---------- <br />-------- <br />: -------- - ----------------------- ------------------ ; A ------------------------------ <br />---------- ) ----------------------- <br />=- _ -----------------------• <br />----------- ------------------------- <br />fe ------------------------------- <br />1 <br />------ <br />---=--=-•-----•-=------- .._------------------------ <br />� -------------------------------------------------------------------------------------- <br />--------------------------- <br />i-------------------------------------- <br />----------------------------------------------------------- <br />­A <br />---------- <br />X. <br />YN <br />F1 12" INSPECTION BY: ---- <br />-Date ------ - - -- - --------------- <br />-------------------- <br />------- <br />­----­-- <br />--- -------------- ------- <br />• <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street <br />t_ <br />300 West Oak'Streef 132 Sycamore Street <br />814 North '-'C" Street <br />Stockton, California <br />Lodi, California" Manteca, California <br />Tracy, California <br />ES -9-2M - Rev;se6 1-57 F.P.00. <br />