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VA V .24 <br /> APPLICATION FOR SANITATION PERMIT Permit No. -2s-- ------------ <br /> (Complete in Duplicate) Date Issued - _L - <br /> ----- - �_/ 5---- .3 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h r des 61jed <br /> This <br /> 'cation is made in compliance with CountyOrdinance No. 549. <br /> c—o Aj-3 <br /> TO <br /> ..... --------- <br /> JOB ADDRESS AND LOCATION...... ------W-! <br /> a Phone <br /> Owner's Name----------------------------------------- Pho ----------------0�7 <br /> ------------ Pho <br /> Address-------------------------------------------------- ---- -- - -------------------------- ------ -- ----------------------- <br /> Contractor's Name-------------------- ------(?a&� ------ ------------------------- ------------------------------------------- Phone-----. --------- <br /> Installation will serve: Residence Eff-, Apartment House E] Commercial El Trailer Court 0 Motel El Other El <br /> Number of living units: Number of bedrooms _V Number of baths __/--- Lot size -------------------------- <br /> Water Supply: Public system Community system E] Private [] Depth to Water Table IS ft.I— <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [-] Clay Loam [j Clay 0 Adobe[g, Hardpan 0 <br /> Previous Application Made: Yes L] No $_ New Construction: Yes9_ No 0 <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-dM)___Distance from fWndation_ -----Materiai----- --- <br /> No. of compartments---1�--------------- ----Size4m"4 a 6 " <br /> x ..... ------------Liquid d e pj h ...............Capacjfy__jFP92__y_0L4 <br /> 6 3' <br /> ro� <br /> m U <br /> Disposal Field: Distance from nearest well-90AA./...Distance from f undat;ont_444�------Distance to nearest lot line-__-_--_/-O' <br /> Number <br /> ine-------- <br /> Number of lines________,'_________ Length of each line------549:7�.Wiclfh of trenO---2A5K�------------------ <br /> Type 07 filter <br /> ----Depth of filter mafe,iii-------49---------Total length---- --'S?rA----------------------- <br /> it: Distance to nearest we14401v_3--------Dist6Fcofrom founclationIS-----------Distance to nearest lot line---149 <br /> Seepage P1 Number of pit s`_/----------------Lining 'material__ -I Depth_.. <br /> mater __tic�uOize: Diamefer-1.7-3----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....4—------------Lining material___.__._________._________________. <br /> ❑ Siza: <br /> aterial------------------------------------- <br /> Size; Diameter�-------------- <br /> --------�If•-------Depth--------------------------- ------#--------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from rearest--well---�*--------------------------------------------Distance from nearest building____._______________________..____..__. <br /> F1Distance to nearest lot line-----------------------------------------------------------I---------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):------------------------------------- ------------------------------------------------------------I-------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------I-------------------------------------------------------------------------------------------------- <br /> ---------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ ----------- --•---------------------•-----•-------------------------------- ----------------......... ------------------------------------------------------------------------- <br /> I hereby certify tV6 prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la,4s and ru' s and reZulations of an Joaquin Icall Health District. <br /> t <br /> -------4-------- ---- ------Z ------------------ _PwRer sndy4wContracfor] <br /> (Signed)--------------------------4_19R_ - VI-C <br /> By:------------------------------------------------------------------------ --- --- -----------------(Title)------- <br /> -----(Title)------- - -- - - --_---------- <br /> (Plot <br /> —---------- <br /> fion to wells,lu j7_ <br /> (Plot plan, showing size of lot, location of system in is,"il I n s, etc., can e- _n reverse side). <br /> $01-P + <br /> FOR DEPARTMENT USE ONLY <br /> APPLICAT --- -- ---------------------- <br /> _aN ACCEPTED BY------------------------------------------------- ---- ---------------------------------- DATE-----------L4--- <br /> REVIEWED TBY---------- lye� <br /> - ----------------------------------------------------------------------------------------------------------------- DATE---------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------- ----------------------------------------------- DATE-------------------------------------- --------------------- <br /> Alterations and/or recommendations:__------- ----------- -- ------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I----------------------------------------------­--------- ---- -------------------------------------------------------------------------------------------------------------•---------------•----------------- --------------------------------------------------___­------------------------------------------------- ------------------------------------------------ ------------ <br /> ------------------------- --------- ------ ---------------•--------------- -------- ------------- ----•----I---•------­­-------------------- -------------------------------------�7-_----------------------------------- <br /> FINAL INSPECTION BY:_----xi�e---------------------I------------ Date-- ------ P------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />