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A _ICATION FOR SANITATION PERS.-_ Permit No. <br /> (Complete in Duplicate) <br /> 71 <br /> _t,o <br /> _ _IS <br /> IVA Date Issued ... ... <br /> Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to t t and instali4he workh ri)57d. <br /> , rnstruc <br /> This application is made in compliance, with County Ordinance No. 549. 1_<1/ _ (( <br /> _ . '� I T <br /> JOB ADDRESS AV LOCATION....... ---Ali <br /> V00 ......................... . <br /> --------- -----71------At" <br /> Owner's Name----5,,;,r-ow cel. ......mwnogs---------------- Phone- <br /> ------------------------------------------------------------ <br /> Address----------------1-54-d"t. -------------------------------------------------------------------------- <br /> Contractor's Name- 11 10 <br /> --------------------- M­1gS,?V2�._J!W.d------------------------------------------------------- Phon <br /> Installation will serve: ,Residence E] Apartment House [] Commercial K Trailer Court [] Motel ❑ Other E] <br /> Number of living units: Number of bedrooms Number of baths Lot size ------------------------------- <br /> Water Supply: Public system ❑ Community system El Private 54 Depth to Water Table S&-ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel Ej Sandy Loam Ej Clay Loam [:] Clay E] Adobe Hardpan E] <br /> Previous Application Made: Yes [-] No X New Construction: Yes A No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) <br /> I - <br /> Septic Tank: Distance from nearest well -------Distance frop foundafion.j....�i,:---------Material--d"_062��_::.- <br /> 4 ------------- <br /> No. of c'ompartmenfs___'V-------------- Liquid clep�h_ 119Lo <br /> -;F1,0•---------------Capacity...91W----------- <br /> Disposal Field: Dista*n-c-e from nearest well------------- from foundation--------------------Distance to nearest lot line................. <br /> El Num;er of lines____________________________ Length of each line------------------------- Width of trench----------------------------------- <br /> Type of filter mater�ial.._----------- Depth of filter material-----------------------Total length_.-________._.----_--_________._._...... <br /> Seepage Pit: Distance to nearest.1well-1-0a".....---Distance from foundation-.?--------------Distance to nearest lot line-4.10-------- <br /> Number of pits- !_ Lining ma teriaL-RA)_tAo....Size:i Dia mete !A3----- <br /> 'r__ --------.Depth--.To----------- -- <br /> --- ------- )4 <br /> 4FAC ------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________-__________,_.__--..__----._.i <br /> El Size: Diameter--------------------------------------Depth------------------_.......I------------------ Liquid Capacity..-------------.-----------gals. <br /> Privy:-- from-nearest-we -------------------- <br /> A rorn-nearest-we - ------------------------.--Distance from nearest-build ---- --- <br /> ------------ ----------------- <br /> El Distance to nearest lot line-----=------------------- <br /> ------------------------------------------­------------------------------------------------ <br /> Remo sling an4/,Or repairing, describ :I ----- <br /> - _1... <br /> desc -- -- - ---------- ....... <br /> %;r 'xJ?0!!Ve <br /> E - - <br /> :Awf;f2 <br /> -----Y__uA0q4j0C......ANZA-------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----- -------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> .1 <br /> , I hereby certify that Ihh!ve aced this application and that the work will-be done in accordance with-San Joaquin County <br /> ordinances, State laws, apd-f les a regulations of the San Joaquin Local Health District. <br /> aY/o�5ntractor) <br /> (Signed)___________________...le__ -------- ..... ----------------------------------- __(Own9r. <br /> A.,�' <br /> - - - ------------ <br /> By:..................... ---------zr�_l---------- ---e;----------(Title)-,----- ---- ---- side). <br /> . ------------------- <br /> (Plot plan, showing size of lot, location of system in relation o wells, buildings, C., can be pla/d on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B ------- <br /> Y� - ------------------------------------------------------------------------------------- DATEe <br /> Z��--------------------------------------------------- <br /> REVIEWED BY.... <br /> . .........---- --------------------------­------------------------------------------ DATE... r <br /> .................--------------------------------I <br /> BUILDING PERMIT ISSUED_............................................................. ------------------------------------- DATE----..... <br /> WV--------------------------------------------- <br /> Alterations and/or recommendations:-----------................................................................................................................................................... <br /> -----------------------------------------------------------------------------­............................................................................................................................................... <br /> ---------------------------­ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------..................... <br /> -----------------------------------------------------------------------------------------------------------------------------------------............................................................................... <br /> ................I----------------------------------------------------------------------------------------...................... ­­------------------------------------------------------------ ------- <br /> FINAL INSPECTION BY`�.-. -----------_-------------- Date-----------)I-- <br /> ----------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California- Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br />