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Z'�LICATION FOR SANITATION PERS, Permit No. .........77; <br /> (Complete in Duplicate) <br /> Pate Issued _7­0124�A' <br /> Applica-lion is hereby made to the San Joaquin Local Health District fora permit to construct. and install the work herein described. <br /> This application is made in compliain,ce.with County Ordinance No, S49.- <br /> JOB ADDRESS AI� ----------- <br /> ------0 Y <br /> C zv , rh-&.-_-E ..O-P <br /> Cb��- --_0_ . -&- 0 - <br /> LOCATION - - ---------------- ;- <br /> Owner's Name__.7:1_G1__j-j----------------- --------- ----------------­------­­ <br /> Address------- 4.10_1--------L__,----- -—----------------_.­ ............... ------------------------------------•--------------------•....... <br /> Contractor's Name-----------r �k--- - ----------- ---------------------------------------------------- ------------ --------------­ Phone----------------------------------- <br /> Installation will serve: Residence Apartment-House El Commercial E] Trailer'Court [I Motel El Other '[_I <br /> Number of living units: ---- Nhuber of bedrooms ___/Number of baths Lot size -------------------- <br /> Water Supply: Public system Community'system El Private [-] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] .:Gravel E] Sandy Loam El Clay.Loam E] Clay [j Adob Hardpan E] <br /> Previous Application Made: Yes [] No New Construction:Construction: Yes-V No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> y <br /> (No septic tank or cesspool nearest <br /> p6sowale :Z0feSeptic Tank: Dtancefrom well-Kn Disfan�e from fou-ndation.-.71- -------- IvISferi-k-0-------------------- <br /> - ------------- <br /> -depth.L" C a p a t f y.!.�k_ <br /> - ----- ------- <br /> No, of compartments-_-Y`*---------- _'Size_-;�-Y'i7f Liqyid - <br /> is <br /> Disposal Field: Distance from nearest well___ bista'nc-e .frbin.-f6u.nd&ficin.--I-IZ)----------Wistance to nearest-lot line___,. ----------- <br /> or ------ _6f ac h line___4e_-.0------ --- Width,of trench------ :�_____________ <br /> Type <br /> 1 lines------>_1----------_ Le <br /> -------LC_D d4C9-x&+eriaI__ ------------------ <br /> Type of filter rnaferials--e—e .....12 <br /> Seepage Pit: Disfahce fo nearest well-------- 7 <br /> --------------Distanc 0�m-foundation---------_---------Dilstance'to nearest lot line__-______________ <br /> DNumber of pits--- ------------------Lining maferialc?_'_-.�....--=----------Size: Diameter-----•• ......-Dep n-----------:----------------------- <br /> .1- 'I .1 1. / t --- -k -, , <br /> Cesspool Distance from nearest well---- ----Disfar�ce from".-foundafion----------------------L;inin`gmaterial--------------------------------------- <br /> --- ----------------- y <br /> El Size: Diameter--------------------------------------DePfh_,__ - --------------------!-Liquid Capacity------------ ----------------------------gals. <br /> I <br /> --------.-Distance from ndere0 building------------------ii <br /> Privy: Distance from nearest well------------------------------- ---------- <br /> D Distance to nearest lot line."----- -------------------------- <br /> ----------------=---------------------------------------=-----!- ----------------- <br /> Remodel,]. and/or 'repairing (describe):__ ------------ I------ ------------ ---------- --- .............•-____.......-•----•-•-------• <br /> ----------- <br /> ----------- ----------------- ---------- --- ------------- <br /> . .......... <br /> ------------ <br /> �4.... ...... -- -------�-; <br /> ------------------------� ....: - - <br /> . ...------- -----­-------------------- ------------------------ -7-- -- <br /> ----------------------------------------------- ------------------- <br /> .. .... ..... <br /> - <br /> ------------------------ ----- <br /> I hereby certify that I have pre n and that the work will be dorie1n accordance with San Jo"quin County <br /> k !I <br /> ordinances, State laws, and rules'and regulations of the San Joaquin Local Health District. <br /> 0 <br /> ..... ------------ ---------------z------- -------------- -----------------(Owner and/or Contractor)----------- ---------------- ------I------------------------------------------- � ' . <br /> Y'... ---------------------------------------------- ---------------------------------- -------- ......I -----(Title)-------------- <br /> • <br /> (Plot plan. showing size of lot, location of system in relation to etc., can be placed on reverse side). 1: <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY----------------­------------- ._--_--- -------------------­------------------------­------­ DATE-----_------foe---------- ----------:1----------------------- <br /> REVIEWED BY---------------------------------------------I------------ ------------------------------------------------------------------ DATE-------- -----<3 <br /> ------ --------*--------------------- <br /> BUILDING PERMIT ISSUED----------------------------------- - ----- --- ------------------------------------------------- DATE------- <br /> ------------ <br /> ----------------- <br /> Alterations and/or recommendations:------__--------------- ----- .......•---------------------_------ - -------- <br /> I S--------------------------------------- - - 11 <br /> -----­--­------------------------------------------------------------------------ -------- ---- --------------- -------------------------------------- - ----- ------------------------ <br /> ----------- ------------------------------------------------------------------------------------------------------------------------------------------...-._----••----------= I----------------------------------------------- <br /> -------------- .. ........ -------------------------- ------------------------------------ ----------------------------------------------------------------1-1--------------------------------I--------- <br /> ----------------------- <br /> -------------------------------------------------------- ----- ---- ------ - ------------ -------- ------------------------------------------------------------- ----------------------------------------------------- <br /> FINAL INSPECTION BY----- --- ----------------------------1-1--------------------I'_­ Date---/d--- <br /> 1 <br /> ate_._/o--- -------------------------------I----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Amarican Street 300 West Oak.Sfriee�f' 132 Sycamore Street 814 North "C!,1' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> Ea___9_21A 145446 ATWOOD 12-54 <br />