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4 17 <br /> 01 .A) . <br /> APPLICATION FOR SANITATION PERMIT Permit No. _'_67�e <br /> (Complete in Duplicate) <br /> op -eg Date Issued <br /> Applical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County d <br /> 0�r 'npp549 <br /> rnrnl�N p,,r, <br /> JOB ADDRESS ALP LOCATION ---- ------COO-0-0----- <br /> Owners Na - <br /> ...... ------------- Phone/-/------- <br /> ' me------ -- -------- <br /> Address.......91-....-r_..., _A e.`16,0 v--------F�--- -------—---------- _;Aa.il <br /> c ------- -----------------••----- <br /> -------*­------ <br /> ------ ...... C---------------------------- ----------------- Phoneh� <br /> Contractor's Name--------------T <br /> Installation will serve: Residence [] Apartment House E] Commercial 0 Trailer Court [] Motel E] Other 0 Labo P <br /> Number of living units: Number of bedrooms Number bat0he 60 Lotsize ________rtR..______________- <br /> Water Supply: Public system 'O Community system ElPrivate pfh to Wafer Table __------ ff. <br /> Character of soil to a depth of 3 feet: Sand Gravel [:] Sandy Loam [j�'Clay Loam 0 Cla 0 Adobe E] Hardpan El <br /> Previous Application Made: Yes 0 No PNew Construction: Yes 0 No 0,49 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ix 4e <br /> 40 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S-epfic-T k- Distance from nearest well------------------Distance from foundation__________________ --------------------- ------------ <br /> No. of compartments-------- Size--------------------------------Liquid/depth--------------------- Capacity-------- <br /> I - --------------- <br /> D;sposa��blcl: Distance from nearest well _�q__Disfance from founclation-6-71--.W1__-Distance to nearest line-----J-7, <br /> RIO Number of lines_..__-i--------- ------ Length of each line-----ZO-0-----------Width of trench:------.2--50C f ------------ <br /> TypeT f <br /> 0 <br /> filter material-4. )I,,---------.-Depth of filter material___ d-4f------Total length_AW:------------------------- <br /> Seepage Pit: Distance to nearest-we�i------------•---------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 0 Number of pits----------------------Lining material-----------------------Size: Diameter___....._._._.._...___Depth------.-------------------.-.____ In <br /> Cesspool: Distance fi-orn nearest well----------- Distance from foundation--------------------Lining material__.___________..___________-I-------- <br /> F-1 Size: Diameter---------------------------------- -; -----Dept h----------------------------------------------------Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well..-:7--- -----------r-----------------.-Distance from nearest builcling-,_:'----------------------------- -;------ <br /> F71 Distance to nearest lot line------ ---------- ----------- -----------------------------------:---------- --------------------------------f----------------- <br /> Remodeling and/or repairing {describe):--------- ------------------ --------- -------------------------------------•-••--------------------------------------------------------------------------- - <br /> ------------------------------------------------------------------------------------:-------------------------------------------------------------------- --------I---------I-------------------------------------------*------- <br /> ------------------------------------------------------------------:----------­---------------------------------------------------------------------------------------------------------------------------------------------- 4 <br /> ---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- <br /> I hereby er i M�yf d1haYG prepared is applica that.f ork will be done in accordance with San Joaquin County <br /> ces, S(!=ws, � -Teg <br /> ordinances, a. rules an81 tions of e an Joa qujm�qaj .ealth istrief. <br /> ---------- for) <br /> (Signed) -- ---- - - -------- -------------- -------------------------- <br /> -ontrac <br /> By:------------------------------------------------- -------------------- ----------------- - --- --- <br /> ---------------- <br /> (Plot plan, showing size of lot. 6iafion,of system i relati f we s, 'buildings, et can be ed on reverse side). <br /> jer <br /> I <br /> aws,, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.-- <br /> --------- ----------- ......----------------- -- ---------------------------------------- DATE------------ '--- -------------------------------- <br /> REVIEWEDBY---------------------- --------------------------------- --------------------------------------------- DATE------------------------------------------------ <br /> BUILDING PERMIT ISSUED--------------------------------------------------- -------------- ----------------------------------- DATE.---------------------------------------- <br /> Alterations and/or recommendations-------- ------ ------ -------------------------------------------------------------------------------------------------------------------I——------------- <br /> f <br /> ----------------------------- ----------------------------------------------------------------------------------------------------------------------------------- .................... <br /> --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ---------------------------------------------....... <br /> --------------------------------------- --- ---------- ------ ---------- -------------------------=------------------------- ----------------------------------------- -------------------- ------------------------ <br /> ---------------------------------------------------------------------------- -- --------I--------------------------------------------------------------------------------------------- -------------------------------------- <br /> i1 .0--- <br /> FINAL INSPECTION BY:-.------ -It?------------------------------ Date------_/&/­�7)�-_�----------------- <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-9-7m 14s446 ATWOOD 12-S4 <br />