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.... <br />----------------------------------------------------------- <br /> ...... <br /> .................____- --------------------------- --- APPLICATION FOR SANITATION PERMIT Pernnit.No. <br />---------------------_------ --------------------------- <br /> -.{Complete-in Duplicate) <br />- ------------------------------------------------------------ - This Permit Expires 1 Year From Date Issued Date Iss6ed ... <br /> Application/is hereby made to the San Joaquin Local Health District for a permit to,construct and install the woA herein described. <br /> This application is made in compliance with County Ordinance No. 549. C-_ <br /> r <br /> r f OW, <br /> W <br /> Inc( <br /> I 7�4 <br /> JOB ADDRESS AND LOCAT'IbUt _ MIN (21.= <br /> 5 <br /> 7-,-j......-------Pk...... ...... <br /> Owner's Name---- Phone <br /> ------------------------------- -------------------- ..................................... <br /> s _7ZT� , _ - i <br /> Addres <br /> ---------- ------*11-1-------I----------------I——------- ----------* <br /> Conteetor's Name <br /> ;lvI <br /> M_E1K......-----------------------__---------------------------- ........... Phone..........-.--..-.-.-.-.-.--.-..-.-.-.-.-.-.-.--.-.-..- <br /> ... <br /> _46allation <br /> will serve: Resi4ence 0- Apartment House ❑ Commercial [] Trailer Court C] Motel ❑ Other [I <br /> bei of living s I unik---L. Number of bedrooms -------- Number of baths Lot size---------------------_-------- ............. <br /> Water Suo*: Public syst! El Community system [] Private [``Depth'to'Water r Table/ ft. <br /> Character of soill'to a dipfr%f,;.3 feet: Sand [:] Gravel E3 Sandy Loam Clay l2bam b Clay 0 Adobe D Hardpan 0 <br /> AW <br /> e New o -g3f ' <br /> vipus-A:pplication7�M _-Ilf-� C-nsfTrudti6-n­:-Y4-s` -N8"[] FHA�V- <br /> TYPE,,OF INSTA0LATIOW-AND SPECIFICATIONS: <br /> No,:sepflc' +a6k'o�r ce'ss000l permitted if public sewer is available within 200 feet.) <br /> -RE-FA15", <br /> 4 .............. <br /> Septic TaDistance from nearest well---- Distance from fou-- afion----- <br /> No.. 04.80inpartments-----2--- ---------------Size---I�A­... ---Liquid clep�h----�$T:_ ------- <br /> b isposa I-field rest well---5-0-...-Disfance from foundation....1V----------Dis'fan to nearest lot <br /> p Distance-,from nearest ce line.....�?------ <br /> r ....ss r <br /> ..4--- <br /> N6ffibe ,i�f llines--------3.��---------T��-----Length of each line. 20 Width of trench. <br /> Type of filter mate <br /> rial._73P-K-----Depth of I ------Total . --------- <br /> W - <br /> Seepage Pit: Distance to nearest well----------_----------Distance from foundation....................Distance to nearest,lot line_____-___________ jf <br /> ❑ r Number <br /> ine------- - <br /> -Number of pits----•-----------------Lining material...............------�'.Size: Diameter----_-------- Depth-----I------........... ------- <br /> cesspool Distance from nearest well................Distance from founclation--------------------Lin.ing material---________.___...._._._.._____._.... <br /> n Size:-Diameter-------------------------------------Depth--------------------------- -------------- ...Liquid Capacity-------.....} gals. <br /> ............. <br /> Privy: Disibnce from nearest well- -I--------------- -------------------------------Distance from neare f l6uilding--------------- ............. <br /> ❑ t <br /> Dis�iance to nearest lot line---------------------------------:------------------------------------- <br /> and/or repairing (describe):-------------------------------------------------------------------------- <br /> -------­------ ----------------- <br /> Remodelin� --- ......----------------- <br /> ----------------------------I.........................I------------------------------------------------------------------- ...............-- .... <br /> -------------------------7------------- ---------------------------­-- <br /> --t- I <br /> ----------------------------------------I------------------------------------------------------------------------------­----------------------------------1-1------------ ----------------------------------------- <br /> - - <br /> -------------------------------------------- -------­---------­----------- ............-----------------------------------------­­­_ I................... <br /> ------------- ------ -------- <br /> I hereby certify that I have prepared this application and that the work will be done in accord,a-n,ce--with-,San Co_un_ty . <br /> ..,oedinances, State laws,,anid rules and regulations of the San Joaquin Local Health-District. <br />—(Signed).. <br /> --------------- - -----­--------- ---- ------------I--' -------------------- -------------------------------•----_•-----_-•_-:-----=----n-.(Owner-and/or-Gontractor)---A-� <br /> By:•......................................................... ---------------__----------------------I -----------------------------(Title)---------------------------------------- ....................... <br /> (Plot plan, showing size of lot, loA+ion of system in relation to wells,. buildings, efc., can be "placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- - ----------------- -------------------- DATE- /�-----_-j <br /> 1......................... <br /> REVIEWEDBY--------- ------------------- ----------------------------------------------------------- DATE----------------•- ....._.. ._... <br /> BUILDING <br /> ATE------------------- <br /> BUILDINGPERMIT ISSUED--------- .............. ---------------------------------------------------_-- --_---- ------ DATE------------- -------------------------------- <br /> Alterationsand/or recommendations------------------------------- --------------7--------------------------------------------------- •---••-----•---___---------1---------------------------------------------------------------------------------------------------------------------------------------------------------------------------­------------------­--- <br /> --------PR_�FA-b-------17ANK---- ---------'Ff.V1_,jP_T:---------- <br /> --------------------------------------------------------- -- -- -------------------------- ---------------- -------------------------------------I--------- ------------------­--­---------------- <br /> ---------------------------------------- ­ ... ------------------------------ <br /> ---------------------------------------------------------------------------- <br /> FINAL INSPECTI Y:.. N - --- ------- ------- Date. --- ------- <br /> --------------- <br /> SAN JOAQUIN LOC A,CH EALTH DISTRICT <br /> 130 South A6iorlcan Sl <br /> rest 300 West Oak strict 124 <br /> Slycamar,*Street 205 West 9th Street, <br /> Stockton,Californi6 todf,Callforri <br /> Manteca,California-, Tracy,California t <br /> ES 9 REVISED 8-59 2M 5-61 AILAB <br />