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1,;..iPPLICATION FOR SANITATION ►! MIT Permit No. <br /> . <br /> (Complete in Duplicat ) <br /> Date Issued ---- <br /> cl. ' <br /> District for a permit to constriXt and 'install the work herein describe <br /> Applica4ion is hereby made-to the San Joaquin Local Health Di <br /> This ap 11 on is ade 1, 1- County Ordinance No. S49. <br /> J d <br /> D pli ,, n comp)- with <br /> L ' -� t- <br /> DRE <br /> ION. 4----------- <br /> DRIES L I ION.:r4_ <br /> Owner s Name.-- - ------------ --------- one------------- <br /> 44�U ------telt-- - - -------- ------------------------- -- --------------------------------- <br /> - -- ----- ---------­­-------- -- ----------------- -------------------------------------------------------------- <br /> Address----------- ...... <br /> ------------------. Phone-------------------- ---- -- <br /> Contractor's Name---------------- --- -- ------------------------------------------------- ----------------------------- <br /> -----4 <br /> Apartment will serve: Residence FF11 partmerif House 0 Commercial [] Trailer Court E] Motel Other 4 <br /> --I' ' <br /> Number of living units: Number of bedrooms --'- Number of baths .1 . Lotsizeirsa-44-- <br /> Water Supply: Public system Ej , Community system [I Private Depth to Water Table Oz ft. <br /> Character of soil to a depth of 3 fee+: Sand E] �Gravel Sandy Loam El Clay Loam El Clay El Adobe [] Hardpan klb <br /> Previous Application Made: Yes ❑ No New Construction: Yesxppx Z�tz <br /> 96 <br /> De <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available_within 260 feet.) _k <br /> SeEt'�TankS Distance from nearest well--:--------------Distance from f6undafidn--------------__Material---- -- ----- - <br /> No, of compartments Size ---Liquid depth-------------------------Capacity----------------------- <br /> too --------- -------------I-------------- <br /> 4Dis all Fi Disfance.from'n,,5,&"� isfInce",frorn foundation__________ _______Distance to nearest lot line- <br /> ------/ <br /> Number of lines__________________ Length of'each line___-________ ----------Width of trench.__.-. -------------- <br /> 'is a,"i <br /> .......... <br /> X.. .......Total length--------15-S, --------------------- <br /> Type oT' filter material.__._____ t-_Depth of filter material_.__---- <br /> Seepage Pi ., Distance to nearest welISdQ_+__Distance from fcmndafion .____-f__.ej----Distance fo-aearest lot line__Ise---- <br /> P <br /> -4-12.X Ye t, ._,.`,_ffj ------- <br /> ez Number of its.--.-..- material;2-- <br /> `from inz e ------- <br /> wrrncte <br /> Cesspool: Distance from nearest well---------- ------Distance foundati(7�. ------- -- - 1 1 -------------4� <br /> , _ - -1- i4t� Cap!a61yi;,j�---_-------- <br /> -------------------Depth-------------=----------------- ------=------- Liquid.�, <br /> ---------- <br /> -Size.:�.Diarneter_ I nearest building------------------------ ---------------- <br /> Privy-. Distance fror� nearest well------------ - ------------------------ .......-'Distance from <br /> -0;� ------------------------------------------- <br /> Distance to nearest lot line-------------------i4-- ------ --------------------------------------------------------------- <br /> ❑ <br /> Remodeling and/ ------------- - ------------- <br /> or re (dl.,� 4�---- - - -- ------------�S_d:__Pt------ ------------ ---- - <br /> --------------- <br /> - --- ------- ------------------ <br /> .............- -- ---- --------------------------- -- <br /> ---- ---------- --- --- ---------------- - <br /> ------ ------- -------- <br /> ------ - -------- _Au <br /> -- -- -- ---------- <br /> -- ------------ - -- --------- ------------ <br /> - ----- ------ <br /> n <br /> I hereby certify that I have 'Prepared +his a lication and at the work will be done in actor anc in County <br /> ordinances, State laws, and rules and regulations of the San aquin Local Health District. <br /> ------------- <br /> ------- ------ --- <br /> (Signed)--- 6.6 �4-...A-----�_ -- - ------------ ------------------------ -- -----------------------(Owner and/or Contractor) <br /> By:------------- --- -- -- ----------------------------------------------------(Title)------------------------------------------------------------- -- <br /> (Plot plan, showing size of lot, I ation o system in relation to 1 wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY.. .---- - ­------------ -------- ------- -------- ------------------ DATE------ ----------- -------------------- <br /> REVIEWEDBY--- -- ----------------- -------------- - -- ----- ------ --- ---6M --------F------------ DATE -------- <br /> --------- DATE.---- ------ <br /> BUILDING PERMIT ISSUED-------------------------------------- .. ..... <br /> Alterations and/or recommendations:.___-...-___-.--_--._- <br /> ----------------------------------- ------------------------------------------- --------------------------------------------------------I-------- ---------------------------------------------------_------------ <br /> ----------------------------------------------­ -------- ----------- --------------- ---------------- ------------------ -------------------------------------------------------------------------- ------ <br /> ------------------------------------------------ ...... ----­ ----------------------------:------------- --------- ---------- ------- --------:7----------------;----------------------------------------------------------- <br /> --------------­_­--------------- ---------------- ­......... -- ----I-- ------ -•--------------k -------------------------- ----------------------- ------------------------------ <br /> ----------------------------- <br /> FINAL INSPECTION BY;-.-. ---- ---------------- --- ------ Date..... <br /> - <br /> .r SAN JOAQUIN LOCAL HEALTH-DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California i Lodi, Cali;*rnia Manteca, California Tracy, California <br /> ES-9-2m 145446 ATWDOD 12-54 <br />