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APPLICATIC> R SANITATION PERMIT Permit No, _114,13 <br /> ------------------ <br /> (Complete in Duplicate) Date Issued <br /> I q4— 1-70 -01 <br /> Applica,%n is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance wit ounty 'die No. 5 9 <br /> L-A-77-ell-'a7' 19-0tti <br /> JOB ADDRESS AND LAATION,-.-,,,= ------ool--------- --- ---- '--------A- ----------- --- ------------------ <br /> Owner's Name--------- <br /> --------------- - ---- - ------_------------------ Phone-----------------------------------. <br /> -- <br /> Address-------------- ------------------- je)-w q- X.5 I <br /> .e4o---------lim. <br /> .00/1-------------------------------- -------------------------------------- <br /> Contractor's Name--------------------------------------------------------------------------------------------------- ----------------------------------------- Phone--------------------- <br /> Installation will serve: Residence [] Apartment House Ej Commercial [rr"Trailer Court C] Motel [:1 Other n <br /> Number of living units: --- Number of bedrooms ---- Numb baths __r..__ Lot size -)( ). �Td " <br /> f- -- ------------------------------------- <br /> A try <br /> Water Supply: Public system ❑ Community system ❑El Private ��Depth to Water Table 4- <br /> WaterSu <br /> of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy L C1 Ej ay Loom ❑ Clay E] Adobe F] Hardpan E] <br /> Previous Application Made: Yes [_] No 2--�Ne, Construction: 'Yeso��eN, 1-1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4_- <br /> Septic Tank: Distance from nearest well, ---- ---Distance from founclation_/64! <br /> 0- -- ----------Material--- <br /> No. of compartments----- -�-----------Size___�j4_!F_0------------------Liquid depfh------- ......------Capacify-'r -------- -tv <br /> Disposal Field: Distance from nearest weIL-T&V_�'Disfance from foundation,/- istarice to nearest lot line.0-Vt-Y..P <br /> -j6-- - idth of trench---- <br /> Number of lines------ ---1�. Length of each line-7 ------------------- <br /> 7 - � 06 <br /> Type o' filter maferiai----� * epth of filter material__.". -----Total length-------/40_�o------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--______________- <br /> ElNumber of pits----------------------Lining_materiel----------------__-----Size: Diarneter_.-------------------Deptk,,-­ --------- <br /> -- ----------------- 4 <br /> Cesspool: Distance from nearest well---------_------Distance from foundation.__._.___---._- Lining material__.._ __.___________------------ <br /> 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-..--------------------------------------. <br /> ❑ <br /> uilding-..----------------------------------- <br /> F-1 Distance to nearest lot line--- ---- ------------------------------------_----------------------- <br /> Remodeling and/or repairing (describe);----------------------------------- -------------------------------------------------------------------------------_------- -------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- <br /> ---------------------------­­­------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------I-------I-----------------------------------------------------------------------­­------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----_------------------ ------ --------------------------------------- - - --------------------------------------------------------- ----------(Owner and/or Contractor) <br /> BY:-------- ............... <br /> ----------------------------------------------(Title)------------------------------------------- -------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 0 <br /> , TM"T USE 0 <br /> LY <br /> APPLICATION ACCEPTED BY---- --- DATE----- <br /> REVIEWEDBY---------------------------car r ---------- -- ----- ------------------------------------------------------- ------------------ DATE---------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations----------------------------------- --- ------ - ------ --------------------------------------------------------------------------------------- <br /> -------------------------------I---------------------I-------------------------------------------------­­------------------------------------------------------- --------------------------------------------------------- <br /> ----------------------------------------- -------------------------------------............ --------------­- ------------------------------------------------------­­--------------------------------------- <br /> ------------------------------------------------ ---------­--- --------- --------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- ----------­----------------- - -------------------------------------------------------------- ---------------- --- --------------------------------------- ------------------------------------------------- <br /> FINALINSPECTION BY:--------- - - --------------- -------- ------------ Dafe.___A/n ------- ---- ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT x <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Sfre#f <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2m 145446 ATWOOD 12-54 <br />`%� J <br />