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7 ------ <br /> - APPLICATION FOR SANITATION PERMIT Permit No. --------7_.��k <br /> (Complete in Duplicate) <br /> ,�Z.-7_0,576 Date Issued ---Y/j fl <br /> ` o <br /> Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and instal tte work herein descri6ed. <br /> This application is made in compliance w' County Ordinance No. 549, <br /> compliance <br /> nce C <br /> JOB ADDRESS LOCAT &1e <br /> NN - -- --- --- ---AA---- ----------- <br /> Owner's Name---- --------- ----- <br /> e---- <br /> Address--------------IP-t-- ---- ----------r". <br /> ... <br /> p <br /> ---------- <br /> Contractor's Name A ------ --- Phone - <br /> Installation will serve: Residence LyJ Apartment House Commercial E] Trailer Court E] Motel El Of her El <br /> Number of living units. _/--- Number of bedrooms ---X Number of baths R--- Lot size ---------- <br /> Water Supply: Public system E] Community system El Private P� Depth to Wafer Tableya__/ft. JL. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F-1 Sandy LoamClay Loam [:] Clay E] Adobe E] HardpL <br /> Previous Application Made: Yes [] No ��ew Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> nk: CC �3 �Fi JC <br /> Se Distance from nearest weIL-4�'­0-------Distan e from foun ation----to�..........Maferipl,----------------------------------------- ---- <br /> Si <br /> No. of compartments.-._.----- -------- zeL ------_-_____.___Liquid depth____ ----------Capacity---AO- --------- <br /> Disposal Field: Distance from nearest well Dinh Le from foundation---- ---------- -istance to nearest lot line----Is---------- <br /> Number of lines .. .. <br /> ------------/_ V� -- ---Length of each line--- - --- --- ------Aidth of french ------- ------- <br /> Type of filter material_0�> _f,' Depfh' of filter materi I---Z ---------- <br /> Total length_ <br /> See e Pit: Distance to nearest well..Z' 0----------Disf,nceez foundation___ istan nearest ine <br /> Number of pits.- <br /> /-------------Lining material_. blame er D tI -- ----- <br /> 1-4 2- <br /> Cesspool- Distance from nearest wall-----------------Distance from foundation-------------------- -ip' <br /> -_Yng a ri --- ... -------- <br /> El Size; Diameter--------------------------------------De th ------------------------- ----------------Liquid Capaci ----------------------.----.gals <br /> Privy: Distance from nearest well___.------ --- -_________________________________Distance <br /> --------- ----------------------Distance from nearest building------------------------------------------ <br /> F] Distance to nearest lot line----------------------------- -----------------_�t e- <br /> Remodeling and/or repairing (describe):-------------- ------- <br /> ------------------------------------------------------------------ <br /> --------------------------------------- ----------------------------- -------- <br /> ------------I—---------------------------------------------------------------------------­­-------------------------------------------------- ---------- - ----------- --------------------------- <br /> ------------------------------------------------------------------------------------------------------------------ --------------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 reg,ulations of the San Joaquin Local Health District. <br /> 10- �! i <br /> ,��&------- ----------------------- Contractor) <br /> (Signed)--------- <br /> ------------- --- - -------- <br /> By:----------------------------------- ----------- ----------------------- ------------------------(Title)---- <br /> -------------- <br /> 'on c <br /> �ca <br /> _dn r s Vie <br /> reverse(Plot plan, showing size of lot;?,jAcation of system in relation to wells, buildings, etc., can be placed n <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- --- - ------ ----------I---- DATE <br /> - --- --- - - - - - ------------------ ------ <br /> REVIEWED BY------------------------------------------------------------- -- - --- --------------- DATE <br /> BUILDING PERMIT ISSUED----------------------------------------- - - ------------------------------------------------------ DATE------------------------- <br /> ------ - ----- <br /> A]jqiraflor� and/or recopmendations. �4 <br /> ......... - --- -- -------- <br /> :--------- <br /> --------- ---- <br /> ' <br /> --- ---. ... ; ------- ---------7---------------------- <br /> ---- ------ - <br /> ------3 <br /> .19 -------------------- --------- -------- ---------- ------------------------ ----- ----------- <br /> ---------- <br /> -91AAXl <br /> FINAL lNSbtCTION BY... --- ---------------------- -- ----- - --- Date.--------------------;_7ol;,4--------- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES---9-2M 145446 ATWDCD 12.54 <br />