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APPLICATION FOR m-SANITATION PERMIT Permit No. <br /> {Complete in Duplicate} Date Issued <br /> A <br /> Applica11on is hereby made to the San Joaquin Local Health District for a perm,it to construct and install the work herein described. <br /> This application is made in compliance Ordinance No. 549, <br /> Thi e with County Ord�q <br /> V. , <br /> JOB ADDRESS AND LOCATION----------311 11 1441-Anl <br /> ---- C -------P-Aa-kf----------�J-------`----------------------------------- <br /> Owner's <br /> ------------------------I---------- <br /> Owner's Name-------NArY a--- ---------------------------­-'�,�------------------------------- - Phone----, --Hq------2.-1960-- <br /> ------------ <br /> ti <br /> ----- .......... <br /> Address..................13-42------E-asl­q, -------------- --------I—:------------ --------------------------I---- Ho-------3!n7-7-27--- <br /> Contractor's Name-------------- -------------------------------------- Phone--------- <br /> Installation will serve: Residence F&I Apartment House [I Commercial 0 Trailer Court E] Motel E] Other <br /> ❑ <br /> i size ----7-5 x 12bo. ---------- <br /> Number of living units: I------ Number of bedrooms ---I - Number of baths .1.---- Lo -------- -- ---------------------- <br /> t11 <br /> Water Supply: 'Public system 0 Cor!rimunity system El Private K] Depth to Water Table ---2.0- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gr8vqjI El Sandy Loam D9 Clay LoaJ El Clay El Adobe❑ Hardpan El <br /> Previous Application Made: Yes E] Jo DQ New Construction: Y,es Z] No L] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> feet;) <br /> (No septic tank or cesspool permitted if public sewer is available within 200 <br /> leement brick <br /> - -- - --------------_--_-#-_----. <br /> Septic Tank: Distance fro?r�earbsi well--59------Distance from foundation---(3) <br /> Size-----6-1_44----------------Liquid dep!th--------�5-143-1 ---Lapacity-----0-0---------- <br /> No. of compartment --------- <br /> V i ­11�� ." m D <br /> \Disp�osal Field: Distancefromneartst We Distance from foundation---8.-----_81------ .... istance folnearesf lot line----5-1�-------- <br /> en'h--------2' <br /> -----------------Width of trench----------------------------------- <br /> Number of lines-----1.-___1-------------.n-'�'Cength of each line------A()-'-1 4 <br /> "'Type of filter matdial-------rQ-C-X-------D'e—p+-hz'of filter maferial.--151------- -----Total length---K.! <br /> ---------------------------------- <br /> -fr6m -_-__.Dist f <br /> `Distance to nearest e -------------- ---Distance -foundati n ------------------ is nc o n re! ---------- <br /> A 1 51 <br /> Seepage Pit: well___---100' e ;t lot line <br /> 146`mber of pits--------I----- -----Lining material I.... 1C)t <br /> ----- -------%� Size:lDiametdr--------�9 Pth--------------------------- ------- lu <br /> Cesspool: " 'Distdince4r,orn nearest well-----------------Distance from founclation-1--,.— -------- --- nIng terial----------------------------------------- <br /> Z uid Cap�cif�-.------------------------ gals. <br /> 171 S ize diarne`ffer�. -h ------------------------ 'o <br /> ------------------- ---------` ""Depth-.-------------------------- <br /> u i ink -------- -------- <br /> Privy: Distance fl�or n e`6 r 6"S`f-Nq e -------------------------A--------------------Distance from nearest <br /> El —Ditfance o neariest ---------------- <br /> Remodelin anl/2r rl ,Sv a t,e� t rpp em: Full I%- <br /> epairing (describe:_.�AAAW�--- -------------------0------- @A!Lql�!Ag---AYAI� - --­Full--_I%- <br /> t-or the 8 tid 8,18tibim beim ...hqqp-q than th' <br /> i qlpjg.Qr to the existing <br /> stem -­ -----------­------- .....— ----------------- <br /> ----------------7-1----------- ---------------- ibility: The undersigned ownibra , <br /> recomm-� ed 10—,rt- -1 the owne3-Y_.s__full---r9�01P.944----------------I---------------- --------------------—------------------------ <br /> ------- ------ ---- -------- r ­------- -0- - - - --­-------------- --- -----y--Tor new system lbej�]Rg from their houst <br /> assume full and fin - -,, responsi/bi, 1 5 --------------------------------------- <br /> ------------------------­----- -------------------------------- -------- ------ - ----------i---- ----- -----------------------x tem <br /> hereby certify that I have prepaQ'Iis-apAcation and that the work will be done lin accordance with San Joaquin County <br /> ordinances, State laws.' and rules and reguI3 ions of �he San Jo quin Loc.41 He th isfri <br /> Norval Waddell: <br /> -- - ---------------------(Owner <br /> (Signed)-------------------------------------------------------- ---- ---- <br /> L --------------------------------------------------------------- <br /> a deli: <br /> By:-------------- ------------ <br /> (Plot plan, showing size of lot, location of system in re on mow.' Ils, buildings, etc., can 6 placed on reverse side). -0 <br /> FOR-DEWTIVIIERT SE ONLY <br /> 1.J, <br /> - ------------- DATE --------------I-------- <br /> .... ....:------------ <br /> APPLICAT,ION ACCENTED)BY------- -------------i, <br /> REVIEWED'BY------------- ----------------- -- <br /> .... - --------------------- ---------------­----------- <br /> ----------- DAT ---------------- <br /> BUILDING PERMIT ISSUED----------------- --- ------------------------- -- ----- , V . - <br /> Alteration; iand/or' -L---­--------- ---------------- ------------- --------------------------------------------------rec6mmendations:-..------------------------------------- I i <br /> \ I I - ---------------------- - -------------------- <br /> - c�_ A ----------------------------------------------- <br /> --------------------­--- <br /> ---------------- <br /> ------------------ <br /> ---------- - -------- <br /> ----—- ---------- <br /> ---------------------------- ----------------............ <br /> ------------- ------------------- -------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------- --------------------------------------- --- -- -------------'-.--.--.---------------------------•-..-.---._ E .. ------------------ ------ <br /> FINAL INSPECTION BY.--. Date-.---9--------/7-------L5-,*, ---------------- --------- <br /> - - -- - -- ------------------------- <br /> S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 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 Revised W-2100 <br />