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b <br /> APPLICATION FOR SANITATION PERMIT �J � l-310-0S- <br /> (Complete in Duplicate) <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 application is made in compliance with County,OrdinanceNo. $49. -7.1-7 A <br /> JOB ADDRESS AND LOCATION----_ ' milewest___af-_Manteca on ose'Mi-t.. <br /> e <br /> Ave_n„ue <br /> Owner's --------- ------------------ --- -------- ------- -- <br /> --------- --------- Phone_ -NQne ----------------- <br /> Address---------- <br /> ----Address---------- ame----as----abome-- -----------------------------------------------------------------------------------------------------------Ph----------------------------------------- <br /> Contractor's <br /> -----9--96Q7 <br /> �- -�------------------- r <br /> Contractor's Name------------.....A.--M l$H--&- SW5_?----iNC--•------------------- -- one------ ---- -?------------ <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: '[]] Number of bedrooms -k-_. <br /> ] Number of baths M Lot size__-__ 4cre--------------------------------------- <br /> P' <br /> jWafer SuPPIY� Publics stem El Community system El <br /> Character of soil to a depth of 3 feet: Sand 1] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available wifhin 200 feet.) <br /> i Septic Tank: Distance from nearest well----__1+01----Distance from foundation---10t-__-----Material___Cone-CiPC_-Brick <br /> 5�'ttt9uid depth 52;T------------ <br /> No. of compartments---_--_---_a-____---- Capacity__-_800---G---Size---- -_Cesspool: ---- <br /> Distance from nearest well--------------- Distance from foundation--------------------Lining material---- ------------_____-__ _-_------ <br /> Size. Diameter---------------- --------------------Depth---------------------------------------------------- <br /> El-Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------- _----_______------. <br /> ❑ Distance to nearest lot line--_._--------_________________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line------------------ <br /> mmg Number of pits------------ --------Lining r tpisanc4 <br /> ----------- --------Size: Diameter Depth <br /> wDisposal Field: Distance from nearest well--- 61-__ t t-_--_ nce. to nearest lot line__-:from foundation Dista <br /> �- t1 <br /> Number of lines------�'--------------------------Length of each line___----�'OO---tT_-------Wid'th of trench----- <br /> of filter material--------1i"__-3�iDepth of filter material------)8_-........ e - <br /> I <br /> -Remodeling and/or repairing (describe):--------- -----•----------------------------------------------------------------------------------• <br /> ------------------------------­ ------------------------------------------------------------------------ <br /> ---- ---------- ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- <br /> 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, an ul s an` regulations of +he San Joaquin Local Health District. <br /> 1 \(Signed) =:--D. -. � 5 P.A1��I H--------`�----—�---TNC_�.- �.. -' - Contractor) <br /> ..,�1 I Est3.mator <br /> BY: - ----- ------------------------------------------- = (Title) <br /> [Plot plansf showi g size.of lot, location of sy4em in relation to wells, buildings, etc., must be filed with this application). <br /> J FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------ DATE--_._____1.- -- /�f-------__ <br /> ------------------ <br /> -- -- ------- <br /> ----------- <br /> REVIEWED BY--------------------------------------------- I ---------------------------------------------- DATE------- ; --- --------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------------------.-Alterations and/or recommendations---------------------------------- ---------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------- - ---------- ------------- ---------------------------------------- <br /> - <br /> PERMIT N j ---------- -. 1p ISSUED------------- ---- - --- ----(Date) FINAL INSPECTION BY:--- --- -- -- - - -- ------- <br /> ---- <br /> Date-------- ---------------------"-------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />