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V11 <br /> APPLICATION FOR SANITATION PERMIT Permit No. r1,5--- P__?__ <br /> (Complete in Duplicate) /11 <br /> Date Issued -----/ <br /> A�� <br /> p Ir\iic tion is hereby made <br /> e fo 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 tio. 549. <br /> JOB ADDRESS AlVQLO ATIOK,7�190-75�--- ----- -----IiOwner's Name.---- -------- _U(5#-- ----- -------- - ------------------------------- --------- Phone---/v <br /> --t--------------------------- <br /> ?4 Itm-- ------------------------------------------------ <br /> -- ----------- <br /> Address---_------------------- _. - .- - . ___,__, �� f <br /> Contractor's N ------ ------=ZA� ------------------------------------------------ Phone-- ------ ---- ------ <br /> Installation will serve: Residence A Apartment House [] Commercial [] Trailer Court E3 Motel [I Other Ej <br /> Number of living units: ---.---- Number of bedrooms _fes_. 'Number of baths J---- Lot size __-_-1___4__0---(Q--4Z777--------------- <br /> Water Supply: Public system 0 Community system El Private X Depth to Wafer Table 3s7ft- <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam Ej Clay E] Adobe�( Hardpan I-] <br /> Previous Application Made: Yes 0 N OX New Construction: Yes 0 Nox <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 well-----------------Distance from foundation--------------------Material----------------------------------------------- <br /> El No. of compartments-------------_----------Size--------------------------------Liquid depth----------- --------------CaPacifY----­-- <br /> r----- ------- <br /> Field: Distance from nearest well--7-$- --.-Distance from founclaf 1--l-5 -------Distance to nearest lot line. <br /> _l-�� 41 IW7 to. <br /> .1 -------Length of each line-JO Width of french. ------------------- <br /> Number o' lines-_ ----------Total length--------ff--------------------- <br /> Type of filter ma <br /> fe�rja -Depth of filter material-- A--- ----- <br /> Seepage Pit: Distance to nearest wall----------------------Distance from foundation-----.----__-..----.Distance to nearest lot line----------------_ <br /> ❑ <br /> ine----------------- <br /> F-1 Number of pits----------------------Lining material-----------------------Size: Diameter--------------------- Depth-------------------------------- <br /> Cesspool: <br /> epth-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ <br /> F1Size: Diameter---- ---------------------------------Depth----------------------------------------------------Liquid Capacity----------------- ---------gals. <br /> Privy: Distance from nearest well-------------_----------------------------------Distance from nearest building------------------------------ ---------- <br /> 171 Distance to nearest lot line------ ---------------------------- ------------------------------------- ------------------------------------------------- ------------- <br /> Remodelin and/or repairin5__(dncr' -------- —------- --------------------- ----------- jr- <br /> ---------------------------- <br /> 161t-- - ------------- <br /> ------ -------------- <br /> ------- --- <br /> ­�-----------------------------­------- --- -------- ...... <br /> ------------------ <br /> --------------------------------I------------------------------------------------------------­---------------------------------------------------------- <br /> ---------------------------------------------- <br /> -- - <br /> ------------------------------------- ---------------------------------------------------------------------------------•-----------------I----------------- ------------------------------------------------------------- <br /> I hereby cert' that I hay prepared this application and that the work will be done in accordance with San Joaquin County <br /> Stat <br /> ul uin Local Health District. <br /> ordinances, 'Stat aws, a rul s and regulations the San*Joa L rl 'IT' <br /> n or,•�an r actor) <br /> ow <br /> —---------- - - ------------ <br /> .. ... .... ..... <br /> By------------------- <br /> (Plot <br /> y:------------------- --- ------------------------------------- - --- ----------- <br /> (Signed)--------- ---- --------- ----- --- ------- -- - -----------------{Title)--- <br /> reverse <br /> S. <br /> w ia6�on rave �e <br /> (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be p <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- -----------------------------------$/"__b---------------------------- DATE------------- / <br /> REVIEWEDBY-------------------------------- ---------------------------- --------------------------------------------------------------- DATE--------------------•- ----------------------------'---- -- <br /> BUILDINGPERMIT ISSUED---------- -------------------- --------------------------------------------------------------------- DATE------ ----------------------------------------------------- <br /> Alterations and/or recommendations:---------- ------------------------------ ---------------------------------------------------------------- -------------------•------------------------------- <br /> ------------------•------------•------------------- <br /> -----------------------------------­------------- <br /> --------------------------------------------------- ------------------------- ----------------------------------------------------------------------- <br /> ------------------------------------------------------------------------- <br /> ----------I----------------­------------------I---------------------------------------­_­------------------------------------------------------------------------------------------------------------------------------- <br /> --------------- ------------------------ ------------- ------­------------- ---------------------------------------- ------------------------------------------------------------I-------------------------------I---------------------- --------------- ---- - -------------------------------------- ------------ --------I-------------------- -------------------------------------- -----------------4---------------------------------- <br /> P Date_ <br /> FINAL INSPECTION BY------------- �e_ A� ---------- ------------------------------------------------------ <br /> SAN JOAQUIN LOCAL 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 10-52 Revised W-2400 <br />