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• I �� APPE.ICATIO <br /> g5't,.1b N FOR SANITATION PERMIT t9 <br /> (Complete in Duplicate) <br /> Application is hiir by made to the San Joa uin Local, Health District for permit to construct_ q p and install the work herein described. <br /> Thi application is made•in,complianc with County Ordinance No. 549. r ��, C7 4p ^3I <br /> JOB ADDRESS AND.LOCA�TI __... -p- ;, 6x'._c-ou;h.4, Conrle_r---- f... ..��3-- <br /> Owner's Name.............. <br /> rc• Ili�3?1C�i?t:-�. l.1.. .........................................------------- Phone. - =Lc3t.I_. <br /> i * <br /> Address.!.__ P a�_ifornia <br /> Contractor's_Name-- - Tl.-a.. ------ -------------------- <br /> - ------- .......................... Phone__�t'_-__----:---------...... <br /> Installation.w1l serve:/Residence ❑.-A�artment-Houte ❑ Commercial ❑ Trailer Court ❑I Motel ❑ Other Efinery <br /> @ Number ofliving units: ❑ Number of bedrooms Number of baths i- <br /> ❑ ❑1 Lot size------:1--.ac.re.............• ................... <br /> Water Suply Public system ❑ Community system ❑ Private Dc y I 1 <br /> Characterofsoil to a depth of.3 feet: Sand E] Grave[ E] Sandy Loam❑ Clay Loam ® Clay❑ Adobe❑ Hardpan i <br /> TYPE OF-INSTALLATION AND SPECIFICATIONS: �, I <br /> ° <br /> IN* septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic. ank: Distance from nearest well--- ._._Distance from foundation...... ___._.. _,Matrial____� �i?r- riCk <br /> ••----••--•-••------- <br /> e No. or compartments_...._ .......-...Capacity----8_M0_____..._Size._. ! _!_x4?.._._.Liquid depth___..;'_&-4.'__•__.>( <br /> Cesspool: * Distance from nearest well-----------_-----Distance from foundation............. .Lining material-------------_........._--•._------ <br /> ❑ Size: Diameter.................................. Depth-_.-.-----_---------------____ <br /> 'Privy: Distance from nearest well---------------------------------------_-_-__.__Distance from nearest building...- 'J <br /> ❑ Distance to nearest lot line,.........:........................... <br /> Seepage Pit:- Distance to nearest well-__--75!_.__......Distance from foundation_--13_�....._-.Distance to nearest lot line....... <br /> ® Special Number of pits.._.•.--•.-�.--------Lining material.......................Size: Diameter.........................Depth-......25!................ K <br /> Disposal.Field: Distance from_nearest welL._-..___..._...DistanceJr,Arn ................Distance.to nearest lot - <br /> ❑ _<_ Number oflines.....__.__..•......................Length of each line=_.___._..._......___-___.___.Width of trench .------•--------------------- <br /> ` Type of filter material..................._.__.Depth of filter material............... <br /> -Remodeling and/or repairing (describe):..___It1S sal ,r li?Xl _Q <br /> r --- -- ... ... _• ._--On--es ----- __.--- _ --• y___alof <br /> __.._.d_._ <br /> .._# _salid._line...and_installing.... Sandand f lin&---------- <br /> -v.ettical_._.. h _noade <br /> truck_pas.s__.nver_---the- tanks_a d- sver... C� <br /> - <br /> ------------ <br /> ---------- <br /> I hereby'certify that! have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.l :l j <br /> i <br /> {S'e ned ------------- II�lha- ---- -------- . ------------------------•----------•----------------------_--- -- ------ <br /> .._. __ wMnie rr and/or Contractor) <br /> BY:..........Perry..ar_th_4ri--------..............------. Owner- g -� <br /> i <br /> - <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, eta, must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------.. -------- ._ _.-_-___-_....... DATE.._ . ---------------------------------------------- <br /> REVIEWED <br /> ___. <br /> •-- ----.. <br /> REVIEWED BY....................................... DATE...... '` <br /> BUILDING PERMIT ISSUED. ..................................................................... DATE_-...__.....��­ <br /> -••--•- <br /> Alterations and/or recommendations:,......................------------•----•-•-•--••-••--- -----------.......................................... `. <br /> ............................••---•••........................................-••-••-•----------------•-- •----------- ... <br /> r <br /> 1 <br /> ________________................................. �. ..._____._._•__'__-'--...._........................................_.__.._-_........................__..-.e_.__._...................•............... <br /> PERMIT No/ ISSUED ISSUED-------=--- ---f-�•--.fa✓__.(Date) FINAL INSPECTION BY:............ <br /> ...._.... ----------....-- ----------...---- - <br /> Date...................... - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> +. <br /> ES-9-2M 9-50 W-1639 <br />