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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <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 in compliance with County Ordinance No. 549. <br /> JOBADDRESS AND LOCATION-------2813-- North---F--Ct--------------------- --------------------------------------------------------------------- <br /> Owner's Name------T� €18gh�1� ----------------------------------------------------------------------------------- Phone_$F `� <br /> Address`-----=----P-'_q' $ox__9_58 -Llnden.Calif ------------------------------------------ -------------------------------------------------------- <br /> Contractor's Name----- _.D.- tai aux' n------------------- ----------- Phone-9.77909--------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: F] Number of bedrooms g Number of baths TO Lot size_,56X185 r---------------------------------------- ((�� <br /> Water Supply: Public system In Community system El Private E] `�R.1 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F-1SandyLoam El Clay Loam [j Clay ❑ Adobe jk Hardpan ❑ <br /> i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-------�istance from foundation__]_Q-------------Material__Re-dWoo-d----------------_--------- <br /> [X No. of compartments----2 <br /> -------------------Capacity---8©QGAZ-Size_Z_'_X5'-X9_.........Liquid depth---4-1------------------ <br /> Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material_____________-_----__________-___.__. ` <br /> ❑ Size: Diameter--------f-----------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well------------------------- ---------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest1of line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__________.__- 1 <br /> ❑ Number of pits----------------------Lining material-----------------------Size:.Diameter----.-------------------Depth-------------------------------- <br /> Disposal Field: Distance from Weare well------- -Distance fromoundatio"r': 9_______ 'Disiance to nearest lot line--- .Q=_______ <br /> Number of lines_____:___lilt Length of each line__100------18W----Width of trench___24_'_______________________ <br /> Type of filter material._ Z'Qd----- pth of filter material.___________-_________ <br /> Remodeling and/or repairing (descr-sbe):--------------NOM---IlkBela.a f011-------------------------------------------------------------------•----------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- <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, nd rul nd' regulations of the San Joaquin Local Health District. <br /> [Signed) � chi `------------------------------------------------------------------------ {Owner and/or Contractor) <br /> --16 - <br /> Title Cantracto <br /> By:--------------------------- ------------------vosy'sferin <br /> ------------------------------------ (Title)) r' <br /> (Plot plans, showing size of lot, location in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- --e-------------------------------------------------- ------ DATE-Z� --- <br /> REVIEWEDBY----------------------------- ---------------------- --------------------------------------------------- DATE__ �!- ---------- ----------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------- ------------------------------------------------------------- DATE------------�----------------------------------------- <br /> Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------- ------------------------------------ - <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------- ------------------------- <br /> -------------- <br /> -------------------------------------------------------------------------------------------------------------- <br /> 1SSUED_______ _ _ JC' _ -U-----{Date FINAL INISPECTION BY-_ __ -___--__________________________- <br /> PERMIT N , �� ) <br /> Date---------------���0.__�i__- --�---_..� --------------- <br /> SAN <br /> - --------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> 4 Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />