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APPLICATION FOR _.SANITATION PERMIT Permit No: ...f/..� .�.. <br /> (Complete in Duplicate) <br /> Date Issued .... . <br /> Application is hereby made to the San Joaquin Local Health Disfrict for a permit to construct and install the work herein described. 4 <br /> This application is made in compliance with County Ordinance No. 549. 4 <br /> Owner's N Wm and POnfia Johnson pHn1 5...... 2 �`s 4 <br /> JOB ADDRESS AND LOCATION.-...a..H1.. ..doe....o.P„J,ind n.-.Rd..--on..l�ea�._.Bide..of-•A_1 . neRd. --„gtk n. <br /> O. s ams • Phone..... I <br /> Address............ DL...I.,...BOX...1.80, Stk!n.......................... - .... <br /> Contractor's Name..........ppj,$A..-...- ...............­ ....... .... .. --... Phone...q0e....1-77M... <br /> Installation will serv3: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: 1 3 r ? -247C]-b0 <br /> Number of bedrooms... -.. Number o: baths .-. Lot size _..........---................. ... . <br /> Water Supply: Public system ❑ Community system [❑ Private ® Depth to Water Table ..45 ft. "f <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe($ Hardpan [3 <br /> Previous Application' Made:-Yes ® No ❑ New Construction: Yes ® No ❑ FHA/VA:Yes ❑ No Cl <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> L: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ''- <br /> . - ,-- ._.._-.__ 1 �q am le cement (roi nd) <br /> Septic Tank: Distance from nearest wel.-�.- ,, Distanc from ounvation........I? .......M erial........................... .............. { <br /> � No, of compartments.......,...2.,..........Six©.� ...&-.. 2°.-...Li uid de fh- '!�-•�t�.--....Ca Capacity ....._.. ; <br /> �D <br /> Disposal Field: Distance from nearest well.....,.,5.0 Distance from foundatio.-SLIRp1e..Distance to nearest lot line-...0.411. .. f3 <br /> Number of lines--•----•--.1................Lengfoeach I,ne..... �13C .. 0!.....--........W;dth of trench........V....................... <br /> 1YPe of filter material.......raink......Depth offlter material......15...........Total length------4.0............................... <br /> C <br /> F ge Pit: Distance io nearest we!I.........._ .......Distanco from foundation.:..................Distasce to nearest lot line................. <br /> Eaig;ing Number of pifs....:.................Lining material.......................Size: Diameter.......................Depth ............. <br /> x s <br /> Cesspool: Distance from nearest well_.c..-.........Distance from <br /> ❑ foundat.ion...................Lining material.............: ....... <br /> Sze: Diameter.......... ........ ...... Depth.-•----__...........-......... Liquid CapaCity......4..........--.............g.,a.ls;° <br /> 1 <br /> Pr; Distance from nearest well. ...........Distance from nearest building <br /> ClDistance to nearest lot line.......................................... . .................................................................................................................................. I <br /> Remodeling and/or repairing (describe(:....addlno an 8.00---g•a1�--„cement..q":ge tank and.u0 <br /> e _ <br /> .b•�ieting...s.yetem- and•.tying.-lri...to ••existing 361'g2�_�ft. 1 <br /> ........ ......-..... <br /> .----------•-.._......_..................................................................................................................................•.................................................... <br /> ........ <br /> I htereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coutlbe� <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> n (Signed)..........belta..AeT?li.c...Tank..5.�I'ViCBi...I31C................... ............................................(Owes: cad/or Contractor( <br /> B .Ox Y._t� r ............................................•--......--.......... (rifle) <br /> General Manager,-......... <br /> By --- f )........................................... <br /> (Plot plan showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION-ACCEPTED BY........ .-O.!._.,_........ ..............:..................................... DATE...-.... .....:......... <br /> E <br /> �< REVIEWED BY.--.......--•--•...........:..........................•----..:........................................................... DA <br /> BUILDINGPERMIT ISSUED............... ......................................--............:-........----.......-----....DATE........................ <br /> Alterations and/or recommendations:...... .............. ..... .................:._....:...........--•--••-•.................................................................._. <br /> k .j r..... I .'tfN.kC�.........r�... . ..... ..._�....--- <br /> s�-rc --•-----.15 ......D.G.N_ .. -3f ...................................................... <br /> `................ ..1;� �i,/-• � '�' �...... 7- .-..,.......r.............,....-. -. :.-....- .................................... <br /> jl . <br /> !' <br /> I <br /> FINALINSPECTION BY:.............................. ............... -------- Date........................................__ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Str.at 340 West Ott Street 132 Sycamore Street 614 Norah "G”Street <br /> S1ocLt9n, California Lodi, California Mee'sca, Cel;fornls Tracy. California <br /> ES- -2M . Reoiseo 1.57 VPCO. <br />