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OR OFFICE USE: r <br /> F .I L) A? /-Z.2 S- <br /> . .................. <br /> ........ ..... ......._... Permit No. a.2- --,3.;)-- <br /> 4 APPLICATION FOR SANITATION PERMIT .. <br /> ........... . .................................•------- <br /> -------- <br /> ­ --- _ - <br /> I I -" Date Issued <br /> . ..... ............... ..;...... This Permit=YrCr <br /> Daft Issued <br /> made to Son Joaquin Local Health District far a permit to truct and install the work herein described. <br /> AW.cation is hereby milde to corV6 <br /> This Toicatan is made'in com itaftep.with CountyOrdinance tOrdinanNo. S49. I t 7--oso-P <br /> n PI <br /> Cwft&IA-f <br /> JOB ADDRESS AND LOCATION. <br /> Owner's ------------- ............... phone <br /> .......................... <br /> Address...19LA.-.9 —--------- <br /> ' _--._-.._:.•_-..._._...••-..._...... <br /> Contractor's Name.0, ,?7 <br /> installation will serve: Residence Iff--Apartment House 0 <br /> Commercial 0 Trailer Court ❑0 MOW 0 other 0 <br /> Number of livingnits: f _ <br /> . ,Numb .. <br /> ser of bedrooms.1 . Number of baths A- Lot sae t! Er'6"A to Water Table _..... ft. <br /> Water Supply: Public system 0 Community system 0 Pr"f* <br /> 9 [3 Adobe 0 Hardpan 0 <br /> Character of soil to a depth of 3 feef: Sand [] Girevel 0 Sen;J�toara Uk- Clay Loom ay <br /> At <br /> FMA/VA:Yes ErW 0 <br /> Previous Application Made: jif yes,date:...................I No ero�Naw Co4truction: Yes No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> A 142 a- <br /> Sept,c Tank- Distance from nearest well-fe+.-Distan from foundation.._..............Meteri <br /> No rof comportments.........1�t----- --Size....7j.1.( . 0_1....... ......... <br /> ___Liquid depth_-!% ... <br /> Dispos I V-e d 0 isAnce from nearest weliS,0-t_Distance from I ourvdatiori_!�Ot___Distance to nearest lost I!".. <br /> a ��j tran <br /> - 14 Length of each line-----------7X-'­-­Width Of ch-----1 <br /> Number of I._1 <br /> Depth of filter m,terie <br /> A ----.Total length... <br /> Type, 0; filter material...j.zo <br /> - <br /> Seepage P& Distance to nelrest well.....A11_Distince in foundation.... <br /> ,yist6fic'e to nearest lot Urld- <br /> Nur;ber of pits...2---------------Lining M___. te/ Ptk V <br /> &.......Size: Diamater..&Y-Jr.........DO ---" ­------------------ <br /> Dislancefromf rest Distance from foundation............•_-Lining material................ <br /> Cesspool; nea <br /> Six Ir --"*-,-,--Liquid Capacity--------- <br /> ❑ a: Diameter�-----------_-------­----------Diepth-----------------------­, I I <br /> il 1 00 <br /> Privy: Distance from nearest well. -_...--,--,-.-Distance from near building__-a-------'--•-------- <br /> Distance to nearest lot line..........................•-............. <br /> 0 11 1 <br /> Remodeling end/or repairing (describel:------------------------------------ <br /> ------------ <br /> ---------- ...... Joaquin County <br /> ------------- - once with Safi <br /> 14 1 h Fhjtaparod this application and that flea work will be clone in accord <br /> I hereby certify t have the Son Joaquin Low Heam-wrlirict. <br /> ordinances. State laws. and rules incl regulations of <br /> A/or Contractor) <br /> --------------- _4()Wnw ar <br /> (Signed)....... ........ ow...P .......... ...... <br /> -------------------AT 4111101111=;;z <br /> L/ In'cj% etc., can be Placed an rOV4~1111114 <br /> (Mf plan showing sise� kaution of system in relation fo <br /> ENT USE ONLY <br /> . ........ DA <br /> TE_ <br /> ---- FAPPLICATtON ACCEPTED ........--------------- <br /> ...I.. DATE.__...._._-..__._. <br /> ------------ <br /> REVIEWED ------------- <br /> BUILDING PERMIT ISSUED_.............___-4- ------ ...... <br /> Alterations and/or re,ommiindafions:. -....._.­ ------------------------------------ <br /> ................................ ------- <br /> .............. ........ <br /> .......... <br /> ------ -------- ------------- <br /> ............. <br /> Date----- <br /> FINAL INSSMTI BY:_.. ------00 <br /> SAN JOAQUINI LOCAL HEALTH DISTRICT <br /> 124 205 West 9th 5"Oet <br /> Ave, 300 IlVeef 0-k Wee's <br /> Ldi.C.14F.,,eW <br />