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PLICATION FOR SANITATION PERMIT Permit No.a.131... <br /> (Complete in Duplicate) I,�/ <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION......f- :a 4fiz?�r-47 ...... -—----- <br /> Owner's Name---------------------------------•-------- ---- :TWW"j__et I e -9-- --------------------------------- Phone....... ---------- <br /> Address.........------------------------------•------.....---•-- --------------------------------------------- <br /> -------------------------------------- <br /> Contractor's Name ­------- ------4 --------------------------------------------------------- Phone--- -------- <br /> Installation will serve: Residence [R Apartment House 0 Commercial E] Trailer Court El Motel [-] Other 0 <br /> Number of living units. --/--- Number of bedrooms J--- Number of baths __/--- Lot size ------ ----------------------- <br /> Water Supply: Public system A Community system F1 Private 0 Depth to Wafer Table -4/p ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam F] Clay Ej Adobe,® Hardpan E] <br /> Previous Application Made: Yes F] No K New Construction: Yes gj No L] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.] <br /> .1111------- I------e--e_lfdll� ________________ <br /> E& <br /> Tank: Distance from nearest well---/7 --Distance from foundafion--1!2---- Maferia ------------------ <br /> E& No. of compartments---- -----------------S-17:e-�J"'44-6*' <br /> 6 ;_i ___.___Liquid depth___-7�----------------Capacity_..90P <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 /> Type of filter material-------------------------Depth of filter material-----------------------Total length___-____-.________-_-__._______________-._C�6 <br /> Seepage Pit: Distance to nearest ----Distance from foundation/-P-'-��**D-is-fa/-nce�t-ow-ne-a rest lot line__.__________-_C57_ , <br /> Number of pits------/-------------Lining material__(!,66W.....Size: D!amefer___-J_J---------Depth---A4_�---------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----- -------------Lining material----------- ------------------------- <br /> F1 Size: Diameter--------------------------------------DepthZ--------------------------------------------------Liquid Capacity-.--------------------------gals, <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--.-.-_------ ---------------------------- <br /> 0 Distance to nearest lot line--------------- ----------------------------------------------------- ----------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------I------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------I--------------------------------------------------------------- ------•--------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------­------------------------------------------------------------------------- -------- ----- <br /> I hereby cerci y that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> State ef a;w , and rulis and iegulatiohs of the San Joaquin Local Health District. <br /> (Signed)---------------- -4&AZ4_1-----ittd------------------------- <br /> ... Owner and/or Contractor) <br /> Title <br /> --------- - <br /> (Plot <br /> --------------------------------------------------- ----------------------------------------------------------------- ----------- 44�� <br /> (Plot plan, showing size of lot, location of system in relation A6 wells, buildingC etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY_-- -------------------- -------------------------- ------------------------------------------ DATE--- ------------------------------------------------- <br /> REVIEWEDBY----------------------------- .... ---- -- -------------------------------- DATE------ ---------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------ ---------------------------------------------------------- DATE------ Qj1---------------------------------------------- <br /> Alterations and/or recommendations----------------------------------------------------------------------------------------------------------------X? <br /> ------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------- -------------------I--------------------------------------------------------------------------- <br /> ----------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------- --------------------- -------------------------------------------------- --------------------------------------------------------------------------- <br /> --------------------------------------- ---------- -------- -------------------------------------------------------------------------------- -------------------------I------------------------------------------------------- <br /> 'r >-K <br /> FINALINSPECTION BY:--X ----------------------------------------- Date--------------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wett 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-2100 <br />