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,, <br /> APPLICATION FOR SANITATION PERMIT <br /> 42JO <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 descnbla <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-------------- -----------------------F_r-en_ch--CaMP--Reat...M------------------------------------------- .............. <br /> Owner's Name...-----.T4m--jG-•-•GomP_3 J967--- <br /> Address--------------Fxench--Ca.mea--1 eat-.Zk:t-*------------------ <br /> Contractor's Name-----------Lelt&------------------------------------------------- ------------------------------------------------------------- Phone----x-=39,55------ <br /> Installation will serve: Residence [2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 10 Number of bedrooms [I Number of baths [2 Lot size------2OOX20p _______ _______ -A <br /> Water Supply: Public system ❑ Community system ❑ Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q Clay ❑ Adobe f ',".'-Hardpan tj,a. , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation._...___ --.-..__.Material_______.___-_______________-_____-_. <br /> eX[i:3t jjag No. of compartments---2....................Capacity...... QO?-------Size--------------------------------Liquid depth-----_-------. <br /> Cesspool: Distance from nearest well...:.............Distance from foundation--------------------Lining material___--___----_-______-____ _-__ <br /> ❑ Size: Diameter-----------------------------------•---Depth---------------_--- - <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-____ .--,._--_ _---•-_________-- <br /> x <br /> ❑ Distance to nearest lot line---------------------------------=.............. <br /> Seepage Pit: Distance to nearest well_____________•-__-_. Distance from foundation___-____ Distanc to nearest lot link € <br /> $] Number of pits. Lining material. br__ijok-Size: Diameter-_* V.........Depth.... " ' <br /> Disposal Field: Distance from nearest well --------.Distance from foundation--------------------Distancif to nearest loft <br /> gtg Number of lines-------l_________________________Length of each line.....50' Width of trench_.-,-_,_ - ----------- <br /> Type <br /> _-- __ <br /> Type of filter material-------------------------Depth of filter material -r----------------- <br /> Remodeling <br /> ---- --------Remodeling and/or repairing (describe):__•----------­------ <br /> vsr .- cry <br /> ------------------------------------ -- ---•- --------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- ------- -------- ------- ------- -------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin' <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. s �, <br /> (Signed)---------------- alta aratac___Tank. rX V_.. ----(Owner and/or Contract* <br /> By:--------- 1 -- ----- ---------------------(Title)_--Owner_--Mgt''-•----_--------------------- <br /> (Plot plans, showing size of lot,location of syste -i I 'on to ells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------------------- ----------------------------------------------------------- DATE-----•--• .. ' � <br /> ------ <br /> REVIEWEDBY-------------------------------- - ------------------------------------------------ •-------- DATE............................................... <br /> PERMITISSUED------------------------------------------------------------------------------------- --------- DATE------------- •--.. ------------. <br /> ------------------- <br /> Alterations and/or recommendations---------------................................-------------------------------------- ------------•-----•------------- --------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---- <br /> PERMIT No.-/' -.O__Z..... ISSUED__3/,a`-_e/, `__....__..(Date) FINAL INSPECTION BY:.... <br /> Date. -/.-¢� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> P`., ES-9-2M 9-50 W=1639 <br />