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J'S 19 too APPLICATION FOR SANITATId­N PERMIT Permit No. .1... ...0........ <br /> � � ?-- <br /> (Complete in Duplicate) 7 <br /> Date Issued --- <br /> L)—IV <br /> Application 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 /> E lei! <br /> JOB KDbKLsS AND LOCATION- ------------ - -- ------- ------- <br /> Owne fZo <br /> 0-------------- <br /> r s Name-----W <br /> --------------------------------- - - ------------------ ----------------- Phone------------------------------------ <br /> Address....... Ad,27 ---------------------------------------------------------------------------------------------:--------------------------------------- <br /> ------ ---------------------------------- <br /> Contractor's Name----- -- <br /> ----------------------------------------------------------------------------------- - Phone. <br /> - <br /> Installation will serve: Residence Vj`lAparfmenf House F1 Commercial F] Trail& Court E] Motel ❑ Other ❑ <br /> Number of living units: ---/--- Number of bedrooms 4__ Number of baths li.- Lot size --- 49.41, "l.1______________________________ <br /> Water Supply. Public system .0 Community system El Private :g?Depth to Wafer Table _Y_47 ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam []j Clay Loam [ Clay E] Adobe E] Hardpan ❑ <br /> Previous Application Made: Yes E] No R?O' New Construction:. Yes g;j-No E] FHA/VA-.'Yes 25o­'No F1 <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 weli----J-49----Distance from foundation....69-------- Mat9rial-_ �-a <br /> e04-w - ___:------- <br /> W001 No. of compartments......X—__--------.__Size__%Zk"'AA/40!!_Liquid ----- Capacity---If <br /> Disposal Field: Mstance from nearest well___-nE_6 _.Distance from foundation---4?----------Distance to nearest lot line---4---------- <br /> Number of lines-------- --- Length of each line--- --------------Width of french --------------------- <br /> Type of filter rnaferial---/_ AW&pth of filter maf6lial------ jotal length-____e*.4—d, <br /> f 01 W------------------------------ <br /> Seepage Pit: Distance to nearest well- _e040-------Distancer m fouh. aflon---- .......Distance to nearest lot <br /> Number of pits.---- ---------------Lining material-/- 747 VC0. ize: Diameter-_!W!"-------- ----------------- <br /> Cesspool: Distance from nearest well-------------------Disfan"ce from foundation--------------------Lining material_____-_-____--______._______________' <br /> El Size: Diameter------- -- <br /> - Depth------------------------------------------------------Liquid CapaC'+YL---------------------------gals, <br /> -----------------------#---- <br /> Privy: Distance from nearest well________- ----- <br /> -------------------------------- Distance from nearest building________------------______________.____1 `' <br /> ❑ Distance-to <br /> uilding--------------------------------------- <br /> Distance-to nearest lot line--:--- ----------------------------- ------L­-------------------------------------------------- <br /> L---- -----------L <br /> Remodeling and/or repairing (clescribe):,:n---- -----------41;�------- e ------ ------ <br /> f <br /> -------------------­------------------------- ---------------L-------- V.L-----------------L--.--L-------------------L ------------------------L--------------------------------r--------------- ----------------- <br /> ------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------L-------L--------- <br /> ----------------------L-------------L­--------- ---------------------------------------------------- ---------- --------------------------------------L-----------L------------------------------------------------- <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 re4ulations of the San Joaquin Local Health District. <br /> Sgned -----( iWA - --------- ------------------------------L---------(eContract o. <br /> By:---------------- ------- 4---- ---------------------------------------%------------------------ <br /> ---- ------- --------------- <br /> (Plot plan, showingfdize of lot, location of system in relation to wells, buildings, etc., can be placed on neve se side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION,ACCEPTED BY------ - --------------------------------------------- DATE-----------•--------------- ------------------------- <br /> n:---------­3---7----------- ­ <br /> REVIEWEDBY---------------------------------- -------------------------------------------- DATE------------ <br /> PERMITISSUED------------ - - _ - ---------------------------—-------------------------------------- DATE--------- ,►_e!--------------------------------------- <br /> Alterations and/or recommendations:-- ---------------------- ------------------------------------- --------------------------­--------------------------------------------- <br /> ------------(---------------------------------------------------------------------- ------------------ ------------------------- -----------------------------------:­---------------------------------------------------- <br /> ------------- ...............4,_4i 'm---------- ----------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------- --- ---------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION-,BY-------=----------- 2 <br /> 414,C4,.')-------I------------- Date----------`e-,/ ------------------------------------- <br /> /AN JOAQUIN LCCAL,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 Revised 1.57 RP.00. �V <br /> _J& r <br />