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APPLICATION FOR SANITATION PERMIT Permit No. -- ----- <br /> (Complete in Duplicate) Date issued z/� 1-P-p.,_4 <br /> gA edescribed. <br /> plica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her <br /> This <br /> applic6fion is made in compliance with Cunt rdina e No. 549. <br /> A I -- --- --- -------- ----------- <br /> �/04 JOB ADDRESS AND LPC ON . V <br /> �'Owner's Nam ------- .. ----- ---- ------------------ ------------------ Phone--, --- --- <br /> - ------- ----- -- - -- --------// ----------- -------------- ---------------------- ----- ..................... <br /> work here i <br /> N <br /> Address <br /> ,K9 4Con'tracfor's Name-------------- --------- ----------- --------------------------------------------------------------------- Phone- <br /> In'sfaIllafion will serve: Resi encu Apartment House [] Commercial [] Trailer Court ❑ Motel 0 Other E) <br /> Number of living units: -- ---- Number of bedrooms .2--- Number of baths _/---- Lot'-size' _,ra--e---A9- --------------------------- <br /> Water-Supply: Public system,.E]-CommunifYsystem 0 Private J,* Depth to Water Table�,Q ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam Clay Loam E] Clay F1 Adobe E] Hardpan E] <br /> Previous Apolication Made:iYes'D N4. V Now Construction-. Ye <br /> 's,'s� No Ej <br /> 0 TYPE OF INSTALLA�!TIO' NIAN-D,'�SPECIFICATIONS: <br /> ... k'V � # 11 ted if public sewer is available within 200 feet.) <br /> tll� (No septi� tank on ces$pooF'permit <br /> nearest -7e------Distance from founclatic, <br /> %ptic Tank., -1, 11- DistAcejfrom ea-rest weir !6 n-,/ <br /> I - ' Idepth_-- 4 p <br /> --------------- 15 ----Ca' acity-Ie ----- <br /> No: of compartmenls---- -Liquid <br /> -y_-.--Distance to nearest lot line��----•Q <br /> is�'adsal Field: Distance from am <br /> well---------- ......Distance from foundation_____________ <br /> E1\L Numb& of lines------I---------1-------------------Length of each line---------------------- <br /> ;----.Width of trench---------------------------------- <br /> 11 <br /> Tyfilter mate r7ial- 1:-----------------Depth of filter material-----------------1-----Total length_______._.-.._-_____________-------------- <br /> Pe,OT <br /> n _j-___-..Di9fance to -------- <br /> S Pit: Distance fC;-n_e`5�test �veII_/VV_' Di f from foAdafio nearest lot line <br /> -------- is ance I -_4�11 <br /> eVe mate Diam -------------------- <br /> -Number of-pifs­�n -------- --- <br /> r�i a�l eter-------_J51 Depf'n-'--/-51 <br /> -f I <br /> Cesspool: "Itance from nearest well-----------------Distance from foundation-,-_.---------------Li6ing material_.__-____.___ -------- <br /> Is - ----------- <br /> s. <br /> Size.-'4 Diameter--------------------------------------Depth----------------------------------- -----------`--Liquid Capacity-----------------------------gal <br /> PrivEyj: �.Distance from oearest well ------------------------------------------- -Distance from nearest building-----------:.------------------:--------- <br /> El vNfance-fo-nedresf of -----------7---------"!---------- ----------------It------------ -------------A .4 ----------- <br /> �2--------- ---------- <br /> Remod epairing (de's&ib )L: —-----c.,2 <br /> Remodeling and/or{ ....... .. -- ----- �14 <br /> eli g d/or�' e ��rwt <br /> -----------------I-------------- ---- <br /> f--------ii�------------------ ---------------I------------------------------------------1---------------------------- ------------------------------------------------------------- <br /> A� <br /> ----------------------- --------------------------------------------------------------------------------------------------------I------------------------------------------- <br /> -----------------­- ------------- <br /> ----------- <br /> - <br /> ------------------------------------------------------------------------------ County <br /> I have prl 1 19-- <br /> I hereby certify that I 'apared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances,-State la .5, and rules nd regulations of the San Joaquin Local Health District. r FN <br /> .If ---(uw Contiactor) <br /> -nd/or, <br /> (Signed)------------------- ----------------------------- ------------------------------------------------ ner a <br /> ArM ----------------- <br /> By:----------------- ---- --- - ------- --------- ------------------------------------------------------------------------ - --------A'�* <br /> "t location "Sy tc;_O?� �n i 100F <br /> (Plot plan, showing s ion f` stem in relation to wells, buildings, etc., can beitp cad o reverse side). <br /> ye FOR DEPARTMENT USE ONLY <br /> ---------APPLICATION ---------_-------- DATE_t�'------------------------------------------------- <br /> . ....... ........ ......................*----------------- <br /> ------ DATE----- <br /> CATION KC <br /> REVIEWED BY------- ------------- ------------------------------------*­--- --- <br /> �_tj-- --'I ----------------------------------------------------------- <br /> BUILDING-PERMiT ISSUED---- ------------ ------------------------------------^------------------------------------ DATE-------_r,;�------------I--------------------------------- <br /> rnm ---------- <br /> Alterations and/or reco en6+ions:---- yr______n------ <br /> ----------------------------------I—------------------------------------------------------------------------------------------------ <br /> -------------------------------------i-------- .............4 I-------------------------- <br /> -----------------------------------------­--------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------- -------------- <br /> ---------------------------------------------I--------- <br /> ­----------------------------- ---------------------------------- ------------------------------- <br /> ----------------------------- ------ <br /> ------------------- ---------------------------------------------------------------------- ----------------------------------------------------------- <br /> -------- --------------------- <br /> --------------------- <br /> ----------------- <br /> FINAL INSPECTION BY:....... ---------------- ------ ---= ----- Date--------- <br /> N <br /> SAN-JO AQU I N LOCAL HEALTH-DISTRICT <br /> 13.0 South American Street 300 West Oak Street # 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California ir I Manteca, California- Tracy, California <br /> ES-9-12 M Revised W-2100 <br />