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FOR OFFICE USE- <br /> -4 513 <br /> APPLICATION FOR SANITATION PERMIT Permit No. A� ... ......... <br /> --------------t........... -------------- ------- <br /> G <br />------------------ -------- ----------------------------- (Complete in Duplicate) sued Z!2�21"j ' <br /> ires 1 Year sued Date Is ................ <br /> This Permit E From !)�te Is <br /> Application is hereby made to the San 't for a permit to construct and install the work herein described. <br /> Joaquin Local Health Disirit <br /> This application is made in complian6e with County OrdinancF, <br /> 7 - ---------------------- <br /> 0CATIC0N.___-_. u----- <br /> r <br /> ... .......................... --- <br /> JOB ADDRESS A D ----- 6-- --- -------- <br /> Phon A*/ <br /> sar <br /> Owner' Name--•--- . . ..... ­­-C --------- - !I i / ............ <br /> 1 1. -...................Address._ _­ - - -------------------------------_ ------------------------------------- <br /> P h on <br /> Contractor's Name- ... ---- ----4____1------------_------------ ............................. <br /> E] <br /> Ihstallation will serve: Reiidence i Apartment House E] Commercial [] Trailer Court (:] Motel C] Other <br /> /... . ................. <br /> Number of bedrooms i�nber 6j'at s, e—. 2 <br /> Number of living units-.7_ ooms 9-- Nu b h ./__L6t'siz . .......... ...... <br /> sy Community -Private pa <br /> E rlD Depth to W,-ter Table <br /> Water Supply: Public sfem�E] <br /> Character of soil to. a e" Sand [] Gravel Sandy Clay Loam [].,. Clay F Adobe[eHardpan <br /> Chara depth I6if 3 feet- a] E] 1 -1 <br /> r .. ­ "❑'Nj7 -�st�uEfi6n7YIoS7[3 N6gr�FHA/VA- Yestb No <br /> Previous Application Made: (If yes,date-------------------- 15116El Co I <br /> - 1 -1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or.cess pool permitted if pul- ailable within 200 feet.) <br /> ?I ank, Distance from nearest well-----------------Distance from foundaiion_-----------!.---.Material------------------------------------------------- <br /> L7,quid depth------------------------.-Capac;j.........��n..... <br /> compartments ------------------Size---------------------------- <br /> No of mpartments-------- <br /> rest lo; line.::`.......... <br /> from foundation-------------------Distance to nearest sp a Id: Distance from nearest well-------------------Distance <br /> A T, --------- <br /> Number, lines----------------------------------..;Length of each line-------------------------I----Width of4rench- -----=............... <br /> Depth of filter 6`terial------------------I-----Total lengihA-------------I-----------------i__ <br /> Typeoffilter-material------------------j----- mif . ",j, 4 1 <br /> ___4---------Distan ,:V .1.-Distance to ne-ards0of-'Jine--- <br /> See Distance to nearest ell-/4* �� m f ndation--So 10 1-01 <br /> ----------- <br /> Number of pits------ -----------Lining material_ _Size: Diamete;--- <br /> __I ining material----------------- --------- <br /> arest well-----------------Distance from foundation------------ ......L <br /> Cesspool: Distance .i from ne I <br /> Size: Diameter---•------------------ ---------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> ❑ <br /> Privy: Distance from nearest well------------------ --------------- ---------------Distance from nearest <br /> building__-�--------------- r- <br /> -------------- 0.0 <br /> Distance to nearest lot line ---------- -- , <br /> IN <br /> ------------------------------------------------------------------------ -------................... ------------------------------------vt <br /> ling and/or rope irin (descr . ..... <br /> Remode 9 <br /> i4e <br /> -------------------------- -------- <br /> ----------------­-- -------- ----- -------------- I -------I....................- <br /> ............................. --------------­--------------- ---------------------------- ------------- ---------------- <br /> *----------------•-----•----------------••------------------------------------------------------------------ <br /> -----------------------................................ <br /> -------•-•----------•----------- . 11 :t I ------------------- <br /> ----------------------------------------------------------------11---------­---------------- ­---------------------- <br /> ------------------------- ---------------------- <br /> ---------------------------_-- accordance with San Joaquin County <br /> I y repared this application and that the work will be done in a <br /> I heri?b certify that I hi t i <br /> t f the S Joaquin Local al h District. <br /> ordinances,' to e laws, an les ri:d� regulat* ns o <br /> (Sigfied'. ------ ... - ---------------- --- -------------0---------------- -•___-[ net and/or Contractorl <br /> ....... .... <br /> ---- --- --------- ----- ---- 401 <br /> % /I-— <br /> ---------(Title)----------- --f--------------- --------------------- <br /> ----- -- - -- ------ ------- <br /> By:.................................. <br /> e <br /> I hav I Di, <br /> e ZSjoaquin Local It <br /> 01 <br /> .. ........... <br /> :o <br /> oils, bui dings, etc., can be placed on reverse side). <br /> (plot plan, showing size of to�, Iocafiion of system in relation to <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ^CCEPTED, --------------------- -- ------------------------------------------------------- DATE--------- <br /> ----------------- DATE----------------------------------­----------------------- <br /> ------------------------------------------ <br /> -------------------- ------- <br /> REVIEWED BY------_-------------- ------ <br /> i, 11 DATE------------------------------------------------------- <br /> --------------_--------- ------------- <br /> BUILDING PERMIT ISSUED <br /> Alterations and/or recommendations:_______- ------ <br /> -----------*--------------*---------------*--,*-------------------*--­---------- <br /> - --­---------------­--- ------------------------------*---------/------------------*"--- -,- . ........ <br /> ---- ---------------------------- -------------------------------------------------------------------------- <br /> ---------- -----------------------------------,...........1-1--------------- ------------------------ - ................ <br /> --- --------------------------------------------------------------------- <br /> ------------------------------------------------------------- <br /> --------------------------------------------- -­----------------- <br /> ------------- -------------*----------------------------- -------------------------------------- <br /> ----------- -------------*----------------------------------------- <br /> ........... ---­--------- ­­------------- <br /> Y: Date--------------- Z w� ---- ------------------------- <br /> FINAL-INSPECTION 9 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street -124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E8 9 REVISED 8-89 2M 5-61 ATLAS <br />