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FOR OFFICE PSE: <br /> _tv--------- <br /> ------------------- - -------- ------------------11- APPLICATION 5ANITATION PERMIT . Permit No. <br /> ------------ ----------------------------------- (Complete in Duplicate) Date <br /> Issued ....t... <br /> ------------ -------------------------------------------- this Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein deicribed. <br /> This application is made in co6pliance with County Ordinance No. 9,L <br /> JOB ADDRESS AND LOCATION..--7__�O--------0 A........S <br /> q --- ------- <br /> Ilk _j--------------------------m`Owner's Name--------R.........q lei . .................. ------------------------------------------------------- ---------------------- Phone... Z,6,17_2 <br /> AN_, I I 4AJ. 4 <br /> Address---------7-3.G......M__1....... - ------- - - ---------- <br /> - <br /> Contractor's.f Name_ ---------------------------•-----•--•-----•-••-•---............_....... Phone.......... .........__...---------- <br />` Installe+ion will <br /> hone.......... ........ ---------- <br /> - 414,tallati.nwill serve': Residence E] Apartment House C] Commercial E] Trailer Court Cj Motel C] Other <br /> NurrlbiWof 6ing uhitsj .Z-.-Num f bedrooms _1 Number of baths _-t_Lot size ____--&---------- <br /> 4-cell-Am-,-------------W__ <br /> Wagr Supplyt-Public,system;i m—Community system•M—Rriva te []-Depth-tcl,Water-Table-40 ft. <br /> .Az I X.acter of soil to a diV_ li — I tCharpfli of 3 feet: Sand [] Gravel 0 Sandy Loam E] Clay Loam[=-]'L Clay Adobe P--ffaardpan� �; C1 <br /> 4 '0 mNuwwaww-mw _77� 0 1 . <br /> Previ't Application Made:-(-If yes,clp'te-------------------- �,iw Consiruction' Yes [I]IxNlffios-�jg��,F /VA: Yes ❑ No <br /> foo <br /> _ TYP <br /> N <br /> E INSTALLATION AND, SPECIFICATIONS: <br /> (No septic tank,or cesspool permitted 1f public is available within 2000 leet <br /> \Septi7jank- n---1---------- <br /> Distance from nearest well...........----�Distanci§ from foundation --- ------------------------------ ........ <br /> ❑ No of-c-oMpartrne'rits"7�-------------------Size------- depth---------- --------)Capacity................Z..... <br /> 0 k , .i ;6� - - J*- <br /> Disposal Field- Distance from nearest well_._ stance from foundation..10............Distance to nearest lot line....L7...... <br /> M 1[ or <br /> Number of lines------- ----------------------Length of each line....... -----------width of trench---- .............. <br /> jo i <br /> Type of filter material .V_0_r__t.,-',__Depth of filter material ------I'?--------Total length____.__- .............. ...... <br /> It 4� <br /> JSeepage Pit.. Distance to-nearest—well........—--------b_is=nce from­fju"nd�fi_on_.1­_ to nearest lot line.......... <br /> I <br /> %AAV� <br /> 13. I Number 8f pits-------------_------Li;1_9­m­afe1_1i;11--- Diameter-----------------------Depth__.___.__________...______3 -. <br /> C`esspool. Distance from nearest well----------------- Distance from foundation--------------------Lining material_______.._..___.___._..........''.. <br /> Size: Diameter--------------------------------------Depth--------------- ------_------_-------------.__Uquid Capacity---------------------------f Iga <br /> 4 .I, <br /> 77 I't7 r� <br /> Privy- Distan,71rom nearest well-------------------------------------------------Distance from nearest building-------------------------------------__ <br /> 0 Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------- j '!k_0 <br /> ---------------------- <br /> Remodeling and/or repairing (describe)---------------------------------------------------- L <br /> -1... ----------------------------------- .................................................. <br /> ---------------------------------------------------------------------.........................­­............................ <br /> -------------------------------------------------- ......­.............I-------------- <br /> ----------------1------------------------------------------------------------------------------------------------------­-—------ -------------------------------------------------------------------------- <br /> 1 4 <br /> ---------------------------------------.........:-�......--_---------------------------------------------------------------------------------------------------------------------------------- ­,_�------- <br /> ----------- <br /> I hereby certify that I h4ililre prepared this application and that +he work will be done in accordance with San Joaquin--C-ci"unfY <br /> ordinances, State laws. and ides and re I t, the San Joaquin Local Health District. LJO <br /> quia,tons of <br /> (Si§ned)?� ------ ------------ --------------------------------------------------------------------(Owner and Contractor) <br /> .. ....------------ <br /> By:--------------- <br /> (Plot plan, showing size ------­-------------_1------------------------------------------------------------(rifle)---------------------------------------------------------------- <br /> size of lot;[location afion of system in relefion to wells, buildings, etc., can be placed on reverse side). <br /> C <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. -------- ---------- <br /> REVIEWEDBY__------------------------11-------------------- ----------------------------------------------•-• ­----------------------- DATE............................................... <br /> BUILDINGPERMIT ISSUED---!l!---------------- --------------------------------------___­--------------------------------- DATE------------------------------------------------------------- <br /> Atterations and/or recommen4ations------------------------------------------- ---------------------------------------------------------------------------------------------------- ----------- <br /> lf <br /> ---------------­----I----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------;)--------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------...11]----------------------44--------------------------------------------------------------------------------------- ..........I—....... --------------­------------- <br /> ------------------------------------- ....... ------------------------------------------------------------------------------­­­............. ---------------------------------------------------------------------- <br /> FINAL INSPECTION BY:. Dale--- ------------ .............. ------------------------- <br /> -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> 31 Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-89 2M 3-61 ATLAS <br />