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---------------------------------------------------------- <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------------------- (Complete in Duplicate) <br /> ------------------ ------------------------------------- This Permit Expires I Year From Date Issued Date Issued <br /> Application 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 1:2 0.9rd-iA n4rice No. 549. <br /> or -a) I-- Milli 1VTf5cil <br /> JOB ADDRESS AND LOCATION... W > <br /> m4pt. 1_4�.....t4t9�4.... <br /> Owner's-Name______________ <br /> ...V <br /> -------------------------------------- <br /> Address----------;51_�.....5_F )U.0iA AV -it---------&P-N-TEK.09---- ------- --------------------- Phone..------------------- .......... <br /> ------------------------------------------------------I................I........ <br /> Contractor's Name'_MA .5- -i't <br /> .......5EP k SOC r;:---------------- Phone...... <br /> ..Tic Ttq Fe <br /> Installation will serve: Residence ®—'Apartment House 0 Commercial' [] Trailer Court [j Motel [__1 Other ❑ <br /> Number of living units: Number of bedrooms 9.. Number of bath's J Lot sizeJ <br /> ----- ........ <br /> Water Supply: Public system Ej Community(Gravel <br /> m F1 Private P-Depth to Water Table <br /> Character of sail to a depth of 3 feet: Sand [] Sandy Loam [] Clay Loam [] Clay Ej Adobe❑ Hardpan F] <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes 13---No C] PHA/VA- Yes ❑ No <br /> -TYPE�OF-11SISTALLATIOW-AND SPECIFICATIONS: <br /> (No septic tank or cesspool Oerm"fitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nea-r4skill! . <br /> ------Distance from foy—olation-_/V-----------Mate 1al__ <br /> TY ......... <br /> No. of compartments__---��---' --------Size_3)(,_!?Xs5__,_..Liquid clep�h...... Capaci .............. <br /> i.�L. ;�--- QQ <br /> ------------ ty. <br /> Disposal Field: Distance from nearest ------Distance from foundation ------- <br /> Distance to nearest lot line..line...,,.'__~.......---- <br /> Number of lines_....____ lb <br /> ------­--------------Length of each line_____ -------------Width of french------ove---------- <br /> Type of filter material... 4X'-JA`4k__,Depth of filter material-----_/9- r----Total length----_-------5_0....•.. -------- <br /> Seepage Pit: Distance to nearest well;-__ ___.______Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits------------- _0 Lining material--------•-----_------Size: Diameter------------..---------Depth------------_----- <br /> Cesspool: Distance from nearest we 11-----------------Distance from foundation--------------------Lining material._____:___.___......__ <br /> ❑ Size: Diameter---- ----- ---- <br /> ---------------11--------------4....Depth-----------------------------------------------------Liquid Capacity---- -------------- <br /> k I i e-, --gals. <br /> Privy: Distance from nearest:,�VdI1L__,k1-------------------------------------------Distance from nearest ---------------------- 1 -n <br /> P --------------------- <br /> C1 Distance io­niM_Feff­lo-F line I I <br /> _ .. .. , :: -_----------------------------------------------------------------------------- <br /> Ilk. <br /> Remodeling at�d/or repairing (describe):J_W_*qT"U__A------ <br /> ..........--------------- <br /> --- --­­-----------------_- -------------------------------------------------------------------------------------------------------------------------- <br /> . ............................... <br /> !I--------------------------------------------------------- --­-------------------------------------------------------------........ <br /> ------------------------------------------------------.­�L�-------I---------------------------------I-------------------------- <br /> 4, 1 1 - ----------- <br /> I hereby..' fythatlh v prepare hii applicaflow-and that the work wiiI_.b"i_'-,done in accordance with San Joaquin Cou" <br /> ty <br /> ordinances, a lav and rule n fit e SaA Joaquin Local Hea�ltk`Disfricf <br /> (Si nod)------ 1 - ----- ---- -------- ­ --- ---- ---- ---------�4------- <br /> ------------------ -------_-----------f�._!�,_,_(Owner and/or Contractor) <br /> WL- <br /> ------------ ----------------------------------------------------------------------------------- �----------------------------------- ------------ -------- <br /> --- -----------------•-•----------- <br /> ------*-------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------771 0�-------------- <br /> -------------------------------------------------- DATE-----15 <br /> REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE.---- �Z-------------I---------- <br /> ------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------­---------------------- DATE-------------------------- <br /> ------------------------- <br /> Alterations and./,or-recommeinctatio6s:—rte-- <br /> - ----------------­­---------------------------------------------4......... <br /> ---------------------------:------ - --------------------­ <br /> -------------­-------------------------------------------I-------------------------------------------:nr-w -I r--14& <br /> ...,-------�­­-------- ....2 - 2�!...................---------- ----------------- <br /> -------------------------------------------------------- ----------------------------------------------------------------------------------------I.............................--------------.................. --------- <br /> -----------.......................... - - -- ------------ --------- - --- ------ ------------------------------------------------------------------------ ---------------­------ <br /> ­-----------------------------:­_ ---------- <br /> --------- -------- ------- ­ ------------------------- ---_----------------- ...................... --------------------------......... <br /> FINAL INSPECTIO ------ -------- ---P-- -----qw- Date-------- <br /> ­­----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 124 Sycamore 5treet205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-89 214 5-61 ATLAS <br />