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AhrUCATION FOR SANITATION PERV-pe,' <br /> (Complete in Duplicate) —7- <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 Ordinanc,,U <br /> *149. <br /> t- 1:!:_� <br /> JOB ADDRESS: AWLOCATION___.,_,r-'1- ,W--- ff-5---0. 44C4�1�_ ...6-------------- ................ <br /> (�__X- t 'I <br /> ----------------- --- <br /> Owner's Name'-.___A-V---------4 <br /> ------- -- ------------- - --------.- Phonev;&_37,M�------ <br /> Address---------- <br /> ------ <br /> Address----------- -- --------- _19femour <br /> Contractor's N15me...........WX 6----------------------- Phone- <br /> Installation will serve: Residence Apartment House E] Commercial Ej trailer Court E] Motel Ej Other El <br /> Number of living units: 2— Number of bedrooms a Number of baths M Lot sizeC;&0_'1__,K---7-7........................ <br /> Water Supply: Public system El Community system El Private K_ <br /> Character of soil +a a depth of 3 feet. Sand Ej Gravel E] Sandy Loam [-) _Gley Loam 0 Clay Ej Adobe f Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well................Distance from foundation-_------------.-. __....--_.------- <br /> -------4-------------- <br /> El No. of compartments---------- ---------------Capacity-----------------------Size---------­_ •-Material-Liquid- ---------­--- depth.---------------- ------ <br /> Cesspool: Distance from nearest well__ -- ------Distance from foundation-- ------- -�.!_.Lining material_-_._----r------------- ------ <br /> Size: Diameter..-----------------------------------Depth---------------------------------- ----------....... <br /> ?rivy: 1 Distance from nearest well.------- ---------------------------------Disfanqe-from nearest building- --------------- ---------------- <br /> I �kl <br /> ❑ Distance to nearest lot line..-----.---__-_-_------_-___-__--__-__- <br /> Seepage <br /> ine........___---------------------------- <br /> Seepage Pit: Distance to nearest well-----------------..--Distance from foundation-------------------Distance to nearest lot ne---------------- <br /> ❑ Number of pits---------------------Lining material____-.------------ Size' Diameter_-------- ----_Depth------- ----------------- <br /> AN I Field: Distance from nearest well-/2<$------- Distance frorn foundation-A/0-jr ----.-Distance to nearest lot iine-JO,____ <br /> Number of lines LDVL�-- ---------Length of each line----715�!--------------Width of trench-_,Z00, ---- -------- <br /> Type of filter maf'aria1WAiZDepfh of filter material----//�........ <br /> -Remodeling arild/or repairing (describe):- --- ----- - -------- ------ ----------------------------------- <br /> ----------- -- ------—------------ j ----- A1-jk_W-------6 <br /> i .....­ Agex -------U - <br /> ------------------------ --------i---7_,�---6_1V'L------------__-----------_----_--------_____---------------------------------------- --------------------------------------- <br /> ------- -­ ------------ ------------- ------------------ ---------------------------------------------------------------­ ------ -- ----------­­­ ---------------------------- ----- <br /> 1 hereby certify that I have prepared this application and that the work w4*11 be done in accordance with San Joaquin County <br /> ordinances, St te S. a rules awnr?;�ulations A�ofl th an Jo in Local alth District. <br /> 0 <br /> Con a <br /> 'r d <br /> )Owner ard Contra <br /> (Signed) -ftp A------ ------ ---- --- ---- ctal <br /> By:------ j- -- <br /> -- - ------- ----(Title)----------- -- ----------- <br /> (Plot plans, sh;ing a of Idt,location of system in relatio to wells,..bui ings, etc., must be filed this application). <br /> I I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIO� ACCEPTED BY--_-_-___--- -- ._--_b/___ 4--—— --------------------------------- DATE-- --------- <br /> ------ . .... ...... <br /> REVIEWED BY------------------ ------------------------------- --- ------ <br /> BUILDINGPERMIT ISSUED---------------------------- --------------------......_-------____--------------- DAIF------------------------------------------------------------ <br /> Alterations an /or recommendations:--------------_-------------- ----------------------- ------------------------ -------------------------- <br /> ----I-------------------------------------------------------------------------------------------------------------------------------------------------------­­---------------------------------------------------- <br /> -------------7----—-- _--------------­------- -------------_-----------------------------------------------------—-------------- --------------------------------- ...... <br /> ..................... <br /> --------------------------------------------------------------------------------------------------------•---------------•------=I------------_----------- <br /> ........... - ........___-------------------------------------------------­---------------------------—------------------------�W_ ­_jj ------- <br /> PEN* No_ --- ISSUED..... -----(Date) FINAL INSPECTION BY--------- ----- --------- --------------------__-------- <br /> Date---------- - <br /> -------- -----*>—IF - X-1 <br /> - -------- ..................... <br /> 11 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-291 9-50 W-1639 <br />