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APPLICATION ,FOR SANITATION PERMIT <br /> ' (Complete in Duplicate) E Z <br /> Application is hereby made to the.San Joaquin Local Health District for a permit to constr,uet-'and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------------------3019--$enynn------------- - = 1i =i = <br /> Owner's Name---------�$-A__-�.R�$---BB.Ch�ld�i----------------------------- ���- <br /> ( Phone-__U0 <br /> Address----------39-19------L-4'-ny-451.__a�.1,--�----------------------------------------------------------------------I = <br /> Contractor's Name-------•---� �. ._Spt�.0 T`{'�,}�__���'Y _�e <br /> - -- <br /> Pho n e----5-"'5955------ <br /> Installation will serve: Residence 9] Apartment House [I Commercial E3 Trailer Court-,E] Motel El Other 11• <br /> , <br /> ' Number of bedrooms �:. Number of baths ❑(_ Lot size_-_'__�QX-- -- ------------�------•----- ----- <br />.- wit <br /> Number of living units: ' <br /> Water Supply: Public system ❑ Community system ❑ Private EX <br /> Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ <br /> 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspoolpermitted if public sewer is available within 200,feet.) <br /> f 1 <br /> Septic Tank. Distance from nearest well-----251----Distance from foundation-_1Q__'.____.__.Material-____Re-d OQd----------------------- <br /> pr! 26 Ca 4 Size �* x -------.Liquid depth-----_ ---�J---------- <br /> No. of compartments-----2------------------Capacity----- - - -- ----- ► <br /> Ce o I: -frtj Distance from nearest well____�__-�.__-Distance from foundation ____ _________Lining material------- IT <br /> - <br /> p �S I ,,,t fQ 'c <br /> S;ze: Diameter-------- I -......Depth------ � X �7 <br /> Privy: Distance from nearest well____________________ <br /> -__________-______--_-_-----Distance from nearest building------------------------------- <br /> � � <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> I <br /> a <br /> Seepage Pit. Distance to nearest well_____________________Distance from foundation_________._________.Distance to nearest lof,line----------------- <br /> Seepage <br /> Number of pits----=----------------Lining material---------------------- Size: Diameter------------_--------- <br /> Disposal <br /> Disposal Field: Distance from nearest well-________________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> . ❑ <br /> Type of filter material-------------------------Depth of filter material___________-_----______ <br /> Remodeling and%or repairing (describe):---------r_EP,�.-.L' — aaiedcn __t.op----'�--- -ank---r`QMP_19t -E __Ql"�_---- <br /> ----------------------------------- <br /> ------------ <br /> -------------------------------•- <br /> ----------------------------------------- <br /> -------------------------------------- <br /> ------------------------------------ <br /> ------------•----------------------- -- <br /> prep li the San Joaquin Lacal H i b do an -- with <br /> --Joaquin <br /> -- C <br /> - - ----- - ---------- -- --- - ----• ----- -------- - ------------ <br /> I hereby certify that 1 have re ared this a lication and that the work will be done in accordance wi#h San Joaquin County <br /> ordinances, State laws, and rules and regulationsealth District. <br /> ° .. -1 r` %. I ; {Owner and/or Contractor) <br /> (Signed)-------------Dal.�t.a.--SeP 1G._T-ank-.Sar-yrJ-ce----------------------------•=--- --- --- ----- - - <br /> ' le----Qw_ne_n!Mir`_- -------------------------------- <br /> By <br /> ------ <br /> E� <br /> By----------Perry•PP_r-r--V-­Xar-th=----------------------------------------------------------------------- <br /> [it, <br /> (Title) <br /> {Plot plans, showing size of lot, location of system in.relation to wells, buildngs, etc., must be filed with this application}. <br /> - FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------------------- ----------------------------------------- <br /> DATE &_ z° � <br /> !, REVIEWED BY DATE--------------------------- <br /> t ----- <br /> BUILDING PERMIT ISSUED------------ ----------=------------------------------------ --------- <br /> Altera-ions and/o- recomm---- qns'_------ ---- ----------------- --- - ----- ---------s------------ - ------------------------- <br /> ______________________________ ___________ _ ---- <br /> ______________________________•--_____..__--_-____._________-_-____.A__.. ________________..___ <br /> ------------------- �c <br /> c <br /> PERMIT No--------�--4--0------ ISSUED---- ------------(Date) FINAL INSPECTION BY:------ - ----------- -�---------------------------------- <br /> Date------------=-------- ------- -_5---------------------------------------- <br /> SAN <br /> -- - ---------------------•------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9--2M 9-50 WA 639 <br />