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t-APPLICATION FOR -SANITATION PERMIT Permit No. _AkZal... <br /> (Complete in Duplicate) Date Issued <br /> 2-6 3-24,0-1,P <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereldescribed. <br /> This application is mada,.in,complian ith County Ordinance No. 549. <br /> JOB ADDRESS AN LOCATIONAZ- - --------.. .... ----- -------­--...... <br /> 14�_ _ ------ <br /> Owner's Name... ­ ...................... ......... ..................... P ne.................................... <br /> ............ <br /> ----- - ---- ----- )6W <br /> Address-------•--------- ...I . ............ .........................................................................­........................ <br /> Contractor's Name....... - -----_-- ---•---•-•---•-...---------•---------­--------------­----­----........................................ Phone.................... <br /> Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court 0 Motel [3 Other,gLglt� <br /> Number of living units: ........ Number of bedrooms ........ Number of baths ........ Lot size .1.0 ------_------ <br /> Water Supply: Public system [] Community system C] Private Depth to Water Table'71"'f t. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel Sandy Loam 0 -Clay Loam [I Clay[3 Adobe 0 Hardpan ❑ <br /> # x &J i,� <br /> Previous Application Made: Yes E] -No 14 N'ew Construction: Yes No 0 <br /> ;N... LOC.ATI.ON,0-14 --------A <br /> ,e -------4 <br /> ---------- <br /> -4�- T t <br /> ...... ...... ...... "a-------- ....................... <br /> ... .. ....'. <br /> ........... __ zj ...a ..... ...P......................................... <br /> ------------- <br /> ----------- <br /> Residence <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool pe6itfed if..public sewer variable within 200 feSt.)--, <br /> SepticxT istance from nearest we"fSer tv" from foundation....................P-aterjal......... -----------..................... <br /> No. of cornpartm'enfs.......... ...Size------- ...................Liquid clepth..........................Capacity....................... (zs <br /> UX* .6 <br /> 41sosal Field- Distance from nearest wel21 "1_.TjL0'..bisfance from foundation---- Distance to nearest lot 1*1 ;Z�.) <br /> ------- ..... Length of each line...../_91- idth of <br /> 'I __.1 nc ... .... <br /> Number o' lines tre .. ... <br /> 9 _�L_�A ----------- <br /> Type of f* Depth of fitter-material._Z/ -------- <br /> il+er materia(.------- length <br /> Seepage Pit., Distance to nearest well...................._Distance from foundation-------------_-----Distance to nearest lot line-_-_-._-.. _-_ <br /> ❑ Number of pits......L--------_---_Lining material-------.--. --.---.----Size: Diameter---....................Depth................................77 <br /> 1 ' <br /> Cesspool: Distance from nearest well.................Distance from foundation..............._-.11ning material.........._............. <br /> 0 Size: Diameter... I '-'.':-Depth................................ ----------------�Liquid Capacity.............................gals, <br /> — <br /> "'Privy:- <br /> ------------ . — -;.— �— — .- - - <br /> vy:- Disf6nce from nia3"Fr—e—it ........................Distance from nearest building.._._..__....__...__..____..._.._.._._... <br /> F-1 Distance to nearest lot line..................................................................-----------­ ------------------------------------------ <br /> 4 j JL <br /> Remodeling and/or rep ring=(S�scr�ibe):_. .4- ...... ....... <br /> ........... <br /> _e <br /> - ------------------------------------------------- <br /> .. ......... ........ ........ <br /> ------------------_----------- <br /> ----------------------------------- ..................................... ................................ .._._.-..--•--•--..............................._.......... <br /> • <br /> ............................­._­--------­­................................................................................................................................................­....... <br /> I hereby certify that I have preparecl this application and fhaf.+he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-•-- <br /> ...........)............................................... .................. ....................................................................(Owner and/or Contractor) <br /> By:...: x .....................-•--•-. ,.­=,_�---......-----•----.----•- ................._(TiUe....,............ .............•.---...-.-r---------------- <br /> *- <br /> (Plot plan, showing size �4_ ocatZ`no <br /> lii system in relaf;on to wells, buildings, etc., c <br /> a; 0 placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 3Y...........................--------- ---- --- ------­---­-----------------_­­------- DATE---------_--------------_..-•...... <br /> REVIEWED BY........--------------.................... ................_............... DAT1__1 <br /> 92_11 ;5------------------------ <br /> BUILDING PERMIT ISSUED_______________________. DATE.- ............ .......... ................. <br /> Alterations and/or recommendations:........ ............................................................................................._ <br /> .......................---•-----••-••........--•-•.....•--••....................................--•----•---•---•--...............--------------................................................................... <br /> ................................................................................................_...........­­...................................................... ............ ..................................... <br /> i <br /> ................................................................ ................._...........I..................................... ........... ............................................. .............. <br /> .................................................................. .. ... ... .. .... . ........ ......1-1..................... ........................ ................................................ <br /> FINAL INSPECTION BY:.---------- ... ................._........................ Date--------------7 ..........................•--....------- <br /> 1 SAN <br /> ....-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> ES-9-2M 10-52 Revised W-2100 <br />