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1 APPLICATION FOR SANITATION PERMIT Permit No. ______________________ <br /> (Complete in Duplicate) <br /> Date Issued ----------------------- <br /> Applica{ion 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 /> JOB ADDRESS AND LOCATION------ 31-_.Suventh (7th. ) Street. . ._French Camp <br /> - - - - - --------_------------------------------------------------ <br /> 1,van Eubanks Phone <br /> Owner's Name-------- --------------•---------------------------------------------------------------------------- ---------------------- <br /> Address----------------------------------Same---___--------------- FRENCH CAMP . <br /> - ------------------------------------------------------------------------------•-------------- --------- <br /> 46 Contractor's Name-----------DAY__Z.__II_GFiT---SEPT-10----TAUTK---UcV---------------------------------------------------- Phone---------RQ---;-•-- <br /> Installation will serve: Residence CM,Apartment House ❑ Commercial ❑ Trailer Court ❑ - Motel ❑ Other ❑ <br /> Number of living units: ____Z_ Number of bedrooms _ 1- 6�t � 2�t <br /> . Number of baths Lot size ------------------------------------- <br /> Water Supply: Public system Community system Private ®-. Depth to Water Table __._____ ft. <br /> ► T�g <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ 'Adobe❑ Hardpan ❑ \ <br /> Previous Application Made: Yes ❑ No f] New Construction: Yes No ❑ <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__.!Qdz_--Distance from foundation----g_s__________-Material-CC%--$ 1Ck <br /> X_ No. of compartments---------2--------------Size5.6u n6,-i----x-`----Liquid depth_571 .-.-._.----------Capacity._.K( --G. S. <br /> foil <br /> Disposal Field: Distance from nearest well....5Q_t_. Distance from foundation___10-___..._Distance to nearest lot line.____--__-_-__ <br /> Number of lines-------2--------------------------Length of each line_____60t lQa -Width of trench___ ___.______-_ <br /> Type of filter material._j°e :t2C____ .Depth of filter material---_-----------_-------Total length----------1.Qn__.-ft_►-_.-_-..__-_ <br /> Seepage Pit: Distance to nearest well-.100.1---------Distance from foundation----J -_______.Distance to nearest �lir�__ 4_ ___---- <br /> fNumber of pits-----2-------------Lining material__._RCC _._.__.Size: Diameter_.___.2 .-.._..___-.Depth- -S---ft.- '`-------- <br /> Cesspool: Distance from nearest well----------------- from foundation---------- .........Lining material------------------------------------- <br /> El <br /> _..____________________________ __❑ Size: Diameter--------- -r-------------------------Depth--:------=--------•--------- --------------- Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------•---_--------_---------------. <br /> ❑ Distance to nearest lot line-------- - ------------- --------------------- --------------------------------------------------------------------------------------------- <br /> .. r � <br /> F <br /> r4 <br /> r z <br /> Remod i g a d/o.-repainn (describel:------ °' ! = ..... _ - -------------Z <br /> ----'-•------------------------------ --------------`-------------------...-------------------1------------- - •--I-----------------------•--------------------------------------------------`----------- <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, and`rules and regulations of th;Saoaquin .Local Health District. <br /> DAY& NIGHT (� �.a Y Contractor(Signed)------ , --------------Septic-Tai&-Service---- - --- ---- - --------------------------- { ) <br /> 1206 Sa. Eldorado HO 2-7046 Title ___-Partnax'-------------------------- <br /> By:----- = Sfio Toil;Cal'#: ( }(Plof plan, showing size of lot, loca �on of sysem in relawells, buildings, c., can be placed on reverse side). <br /> } <br /> FOR MEPARTIVIENT USE ON Y <br /> APPLICATION ACCEPTED BY-- ----- ------- DATE f <br /> �-- ----- -------------- <br /> REVIEWEDBY------------------- ----------- ------- ------- ------------------- ---------------------------------------------- DATE__1D--------------------------------------------------- <br /> BUILDING PERMIT ISSUED- ------- ----------------- - DATE = <br /> Alterationsand/or recommendations:------- -------°------------------ -- ----°- --------------- ------------------------•-•-------------------------------------------------------------------- <br /> ----------------------------•----------- ---------------------------------- -- ---------------------------- •---------------------------•--------------------•---•-----•-----•---•-------------------•---------••-------- <br /> ------------------------------------------------------ ---------•----------- -------- -------------------•--•----- ....... ------------------------------------------------ ------------------------------------------ <br /> f <br /> FINAL INSPECTION BY:.. - 1 -- Date 71,44­-`=� ------------------------------------------•- <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 145446 ATWOOD 12-54 <br />