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A' <br /> !APPLICATION FOR SANITATION PERMIT <br /> Permit No. -A <br /> --------­------ <br /> (6omplefe in Duplicate) Date Issued' <br /> A <br /> �plica4-i6n 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 Ordinance No.'549. <br /> JOB ADDRESS AND LOCATION App----- <br /> -- <br /> Owner's Name----------- -------- -W� . ..... ..... ----------------------- Phone---- <br /> Address----.'.... ....x4p ----------- <br /> �? <br /> ------------- <br /> Contractor's Name------------ ---Of- L phon <br /> Installation will serve: Residence Apartmentlo,,e a] ❑ Trailer Court 9?"Votel Ej Other E] <br /> Number of living units-.7-3.o Nu -er of bedrooms -------- Number of baths ------- Lot size --__-__ Qtr <br /> - <br /> Water Supply: Public system Community system E] Private F <br /> _] Depth to Water Table 4-p- ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam E] Clay.Loam El Clay El Adobe gj--Hardpan'E] <br /> Previous Application Made: Yes 9-<0 El New Construction. Yes E;--Nu-0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if p1bc sewer is available within 200 feet. <br /> Septic Tank- Distance from nearest we1)AV0W.f___Distance f l.toundation--- <br /> u - ro rr <br /> eleE44-111#No, of compartments------ f.......*------Size----- ---Liquid .............Capacity_.1:!5_(1Z1 <br /> Disposal Fiqld:• Distance from nearesf .well. _'__�--------Distance from founclation---------- ---------Dlistance to nearest lot line____._______..___ <br /> Number <br /> ine----------------- <br /> Number of lines-------------- ----------I---------Length of each line-----------'-----------------Width of french <br /> Type of filter material------------ Depth of-t <br /> ' i--------- f do <br /> Total length-------_--------- <br /> nce to nearest wel�_A_d_W <br /> Seepage Pit: ..Dista rom foun tio 4)......._....:.Dist to nearest lot line----------------- <br /> Number of 'its--------I-----------Linin materi 1 0 A' D 4gT <br /> on .............'_Lining m <br /> _X�_S' Diameter------- <br /> P <br /> Cesspool- Distance from nearest well...... ----------Disfianmrrfogu�ndat; material_____________________________-_------------------- <br /> ❑ <br /> Size: Diameter------ -------------------- --z-------Depth---------------r""'=--------- Liquid Ca�acity- --------------------------gals. )1� <br /> i Z�4;r-- % I. 1i ) 'A <br /> Privy: Distance from nearest wO-------------------------------------------!4�Distan6�'frorri nearest building--------- -------------------------------- <br /> ElDistance to n�earesf lot line---------- -----------r - --------------------------- L� I <br /> P ------- ------------------------------------------ --- ---------- ---------- ------- <br /> .Remodeling and/or repairing Oesc,ibe):-'ft--------------- --- _ : <br /> -- -,S <br /> - <br /> -n- ----- V " ----------------- ----------------- <br /> ------------------------------------------------ -----------------I--------------------------------------U---------------------------------------------------------- ----------7 <br /> ---------------------------------------------- --- <br /> ----- ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------:-- <br /> I hereby certify fhli I have prepared this,application and that the work 111 bi done in.-accordance with San Joaquiril Counregulationsty <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local <br /> Ith District: <br /> (Signed)-- ------------------------ wrier and/or Contractor) <br /> "o <br /> -------- --------------------------(Tif 6 <br /> By: -------_--- -------- - ------ <br /> --------------------- <br /> (Plot plan, showing size of lot, location of sy in relation to wells, buildings, etc.. can 6ep__V_� <br /> FOR DEPARTMENT USE ONLY F <br /> APPLICATION ACCEPTED BY- - ----- - ------------------ <br /> ------------------------------- ------ DATE --- -------------- <br /> REVIEWED BY---------------------- --- ------ ----- ---- ----------------:-- ---- ---------- -------------- BATE_,. <br /> ;!A ----------- <br /> ----------- <br /> k5 --------------- <br /> BUILDING PERMIT ISSUED----•-- --- ------------------------------------------------------------------------------------- DATE--------- V <br /> Alterations and/or recommendations:_--.---_.-..------------- - ---------------- ----------------------------------------------------------- <br /> --------------------------------------- ------------------------------ --------------------------­­--------------------------------------------------------------------------------------------------------------- <br /> -------------------------------I------------------ -;C--------- --------I------------------------------------ -------------------------------------------- <br /> ---------- ------------------------------- <br /> -----------------------------------------�5-------------------•---------------------- ------------------------------------------------------------- <br /> -------- ---------------­--------- <br /> ------------- <br /> ----------------- - ------------------------------------------------------------------ -__--------------I------------------ ------------------------------------ <br /> FINAL---------- - <br /> -------------------------------' INSPECTION BY:----- Date . '' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfree+ 300 West 06k Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145x46 ATwucD I2-54 <br />