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O`Oxx't APPLICATION FOR SANITATION PERMIT Permit No, ....6..I.7,.4 <br /> ... <br /> (Complete in Duplicate) <br /> Date Issued't-----___c/_ 3 <br /> ApplicStion is ereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> DRESS AND LOCATION--- �­�O�-7-------------11--------- <br /> JOB AD ------- <br /> 1i <br /> • Owner' Name-----------------------------------------------•-� --- -tlet.7 01-0-41 <br /> Addres -------------------------- ------------. Phone--- <br /> :1 --./ i <br /> - ---------------------------------------------------------------- <br /> i-------------------------------------------------7 <br /> I <br /> Contractor's Name <br /> -------------------------- Phone------i�F-n4F-A­07----- <br /> Installation will serve: Residence X Apartment House El Commercial El Trailer Court D Motel El Other El <br /> Number of living units: ....L Number of bedrooms -------- Number of baths -------- Lot size --—---------- <br /> Water 115upply: Public system k Community system E] Private E] Depth to Wafer Table <br /> Charac6r of soil to a depth of 3 feet: Sand E] Gravel E] Sandy LoarrvEl. Clay Loam [] Clay E] Adobe, _ Hardpan El <br /> Previou's Application Made: YeSXNo New Construction: Yes ❑ Na <br /> 1� - <br /> E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> lNo septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> e cl -Distance from nearest well_________________Distance from foundation-------------------Material------------------------------------------ <br /> fp ------ <br /> A,,v-!-) No, of compartments---------------------------Size---------------------------- ---Liquid deoll--------------------------Capacity--------------------- <br /> -3 <br /> P161 FiE�d�_- Distance from nearest well------- from foundation--------------------Distance to nearest lot line---_--_---_------ -1 <br /> 4 <br /> of lines-----------------_.--------------._Length of each line-----_------------------------Width of trench.------------------_--------------_ <br /> 1 <br /> rench---------------------------------- <br /> j <br /> i Type of filter material----------------- ----Depth of Pilfer material-----------------------Total length------------------------------------------ -ls� <br /> Seepa Pit: Distance to nearest well-._lknj- Dist nc-e fro fou dat n---ID--- �:Djjsfance fp nearest ]of line______.___-__ <br /> 0 r <br /> ia I e <br /> r <br /> Number of pits-----1----------------Lining ma rer6i a 1�-E&0 XU DiameterDept k- -ol­4-------------------- <br /> e <br /> R1 <br /> Cesspool: Distance fi,orn nearest well-----------------Di-sf`3`nfom ,ndatin--------- --__-____.Lining material.------------------------------------ <br /> 0 Size: Diameter--------------------------------------Depth----------------------------------------- - - - ----Liquid Capacity-------------- -------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.____-_-._-.------_-_--_-------------. <br /> ❑ l Distance <br /> uilding-------------------------------- - ------- <br /> Distanceto nearest lot line--------------------- ----------------------------------------------------------------------------------------------------------------------- <br /> Remod eling and/or repairing {describe):------- -------------------------------------------------------------------------------------- ------------------------------------------------------ <br /> ------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------ -----------------------------------------------------I--------­------------------------------------------------------------------------------------------------------------------------------------------­- <br /> ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------- <br /> I Aereii�y­certif-y 'fh`6t-1,,bave prepared this applicafio�Nncl that the work will be clone in accordance with San Joaquin County <br /> ordinances, State laws, and r)les and re ulations of fhd S " Joaquin Local Health District. <br /> Z7 <br /> -contractor) <br /> (Signed� 0�­�--)'j­ -- -- - --------- --- ------------- --------- -- -----------­�--------------- --- <br /> + <br /> By:----------------------------­........ -­-------------- X------------- 'fie) <br /> ----a--C- <br /> 1 4—.--,-(T i --------- --- -------- <br /> (Plot plan, showing size of lot, location of syste; in�relafion to wells, buildings, "., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------------------------------- --------------------------------------- DATE-- <br /> 105 -­1-,2---­-- -- ----- ,5`3- ---------- <br /> REVIEWED BY--------------------------------------------------------------------------t -.-& <br /> ---------------------------------------------------- DATE------------------- --- ---------------------------------- <br /> BUILDIN, G PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterat ons and/or recommendations:--------------- ---------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------•-----r------------------------------------------------------------------------------------------------------------------------- ---------------------I--------------------------------------------------------------- <br /> ----------I---------------------------------------------------------------- ----- ------------------------------------------------------------------------------------------------- ----- ----------------------------­ <br /> ------------------------- --------------------­------------I- ------------------------------------------------------------------------------------- -------------- ---------------------------------------------------------- <br /> .i <br /> ------------------------------------------------------------------------------------------- ------ ---------- --------- ---------------------------------------------------------------------1-------------------------------- <br /> FINAL INSPECTION BY:-------:--------------- ----------------------//X!'�-------- Date-- ------- ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 136. South American Street 300 West 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 />