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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) <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. S49. <br /> JOB ADDRESS AND LOCATION-----02-,e3 <br /> --- -------------11-14DI-r k+44_4-------- ---------- <br /> Owner's Name_CSe_1e_j�P_n,1_16,_.S&_,q.0A6 7, <br /> AP112 <br /> ddress <br /> -------------------- ------------------------------------------------------------ <br /> Contractor's Name----------------- ��,c-------------------- <br /> ---------------------------------------------I-------- Phone------9 O7 <br /> Installation will serve: ResidenceApartment House [] Commercial E] []Trailer Court ❑ Motel [3 Other <br /> ❑ <br /> Number of living units: ___ --- Number of beclrooms'_�Number of baths -----/Lot size ..... <br /> Water Supply. Public system DK-Community system E] Friva'fe L] Depth to Water Table _-4f/eff. <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel E] Sandy Loam E] Clay Loam E] Clay E] Aclobe& Hardpan [:] <br /> Previous Application Made: Yes- <br /> & No El New Construction: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available'-within 200 <br /> Septic Tank: Distance from nearest well-f'6t+GE---Dis.tan-c�e�---f7r�o7m�-oundafion'r ____.Mat I}- <br /> No. of compartments-. _-�Vi-------- <br /> ------------ <br /> --------Capacity-- 47 <br /> ----------------Si <br /> eo- ----------- <br /> Disposal Field: Distance from nearest well NbAlt..Dis�67—rom founclation/W--------------D\i's-f,, <br /> is 6nce to nearest lot <br /> Number of lines---------I-----------------------Length- of each line---1_Q-`_------------------Width of french.3_-_.:4_ &A, <br /> Type of filter material--- tti -(U%r-----Depth of filter material----- -------Total <br /> Seepage Pit: Distance to nearest well...tiQkkk------Distance from Distance to nearest lot ;ine-----------"I <br /> tt I <br /> meter---- _S7----------------- <br /> Number of its-----I----------------Lining maferial-O& -------Size: Dia Depth------2 <br /> Cesspool: Distance from nearest.well-----------------Distance from foundation_-------___-_------.Lining material---__----__-__----_-_-__------_-----. <br /> El Size: Diameter-------------------------- ------Depth----------------------------- ---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance Distance from nearest,building---____--------------_---_-_-------------. <br /> ❑ Distance <br /> uilding------------------------------ ----------- <br /> Disfance to nearest lot line---/ <br /> .7- <br /> Remodeling and/or repairing (describe):____'(9-------PL&A--ifti-e e'�_--3- <br /> 1--t-------------- <br /> --------- ------- ----------- ------------------------ --- I--------_11---------------------- <br /> "'Mij----------- ----et ------ -------------- ---- -- <br /> ---------- ---- - - <br /> -- <br /> --------- ---- ------------- - --------- ----- ------ --------------& <br /> .. ................ <br /> I here erfify ------- ------- - <br /> that I ve prepared This application and that the work will-be done inP____ <br /> v accordance with San- Joa. uin County <br /> ordinances S�fte laws., and les and regulafi S of the San Joaquin Local Health District. <br /> (Signed)------ --------------- -- - ------ -- - ------------ LIZ- <br /> ------------------------------------------------i-W--- Contra c or) <br /> By:- ---------- ------------------_- ---------- <br /> - -- - --- ------ -A,-- ------------------------------ <br /> (Plot <br /> ---�___j�--------------------- --------------- <br /> (Plot plan, showing size of lot, location of cyst i relation to 4 vls-.-buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> BAPPLICATION ACCEPTED BY -- <br /> --------------- --------------- -----------7DATE ` <br /> --- <br /> - <br /> -- - --REVIEWED BY------------------------------------- ------------------------ -------------------------------------------------------------- nATE--------UILDING ---------------------- <br /> PERMITISSUED------------------------------------------------------=--•------------- 1-1------6-1--------------- DATE <br /> Alterations and/or reco mmenda+ions:.............................................. <br /> -------------------I------------------------------------------------------ <br /> ----------------------------- <br /> ----------­---------I-----------------------I---------------------------------------------- ----------------------•-------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------1------------------------------------------- <br /> -----------------------------------------------­.­------------------------------------------------------------------------------------------------------I----------------------­---------------------------------- <br /> ------------------ -------------------------------------------------------- ---------------------------------- ------------------------------------------------------------------------ ------------------------------------- <br /> FINAL INSPECTION BY:.. ------------- Date---------9/ <br /> ---------------------------- <br /> SAN 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 10-52 Revised W-2100 <br />