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APPLICATION FOR SANITATION PERMIT Permit No. _45___-3 L. <br /> (Complete in Duplicate) /: <br /> Date Issued __./._ _ �A_ <br /> A lic 4ion is perebymade to the San Joa uin Local Health District fora ermit to construct an in tpp q p d install the work herein described. ��- <br /> This application is made in compliance with County Ordinance No. 549. �p <br /> JOB ADDRESS AND SOC TION-- ------ -���/� s <br /> Owner's Name ----••--- 2-----4---------------------------------•----•- --------------- - - ------------I.. Phone------------------------------------ <br /> Address....2-4..... �. ...•G-�'-,r- -t1s' <br /> ------------------------------------- ­ 4 <br /> Contractor's Name__ __. .. Phon�!�-'' A:_�_G_ <br /> - -------------------------------------------------------------------------- ------ <br /> Installation will serve: Residence artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1--- Number of bedrooms -_-__Number of baths __/.-.- Lot size -{ ____. .._.� �-- ---------------------- <br /> Wafer Supply: Public system [ ammunity system ❑ Private ❑ Depth to Water Table _3o ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobaar pan ❑ <br /> Previous Application Made: Yes ❑ No 4--� Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest Distance from foundation__.P___1'__.Material-___ __"apaci;y___ <br /> _____� ._-___. <br /> No. of compartments_....__ .._____._.__Size__ _ . __ ___Liquid depth.... - � ------� <br /> Dis osal Field: Distance from nearest wefl4"It�_Distance from foundation_- t <br /> p �5,_�_�__....Distance to nearest lot <br /> Number of lines-----/---------- Length of each line__:A X� -'___ __________Width of trench----"��1._�!_.___-_----_----.. <br /> Type of filter material--- --------------Depth of filter material----.��-`-------Total length-----2X-'-----------_----_-___.--- _j <br /> 1 <br /> Seepage Pit: Distance to nearest well'o----^ --.-.-.Distance fo ndation..... •I..._..Distance to nearest lot line--_ _ ______ a <br /> Number of pits---- .--Linin material_ r omSize: Diameter_ �' Depth--m-1,q_! <br /> Cesspool: Distance from-nearest well'__-- -----�-__Distance,from foundation--------------------Lining material_-.._--_...__.--_-.-_--.-.-----__-_ <br /> ❑ Size: Diameter- ------ ---------- ------ - - -------Depth- -------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------.-_---___---_-_.--..----.-. <br /> ❑ Distance to nearest lot line----- --------------------------- ------------ <br /> Remodeling <br /> ----------Remodeling and/or repairing (describe):-- ------------------ -----•--------------------------------------------------------------------.........--------------------•----------•---•-------• <br /> --------------------------------------•-------------------------•---------- D <br /> ----------------------------------------------------------------------------- ------ <br /> ------------------------------------------------- <br /> --------------------------- --------------------------•-------•-••--••---------------------------------------•------------•-------------------•-----------•---------------------------------- ------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r <br /> ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. <br /> -- -___ <br /> (Signed) ---- ----- •--�1 ------- - ------- -- - ------- ------------------------------------------------ ------------------------�C�e�wd�or Contractor) <br /> y• (Title). ` <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 - ----- ---- -------- ---- -- ---------------------------------------- DATE----'J- -- --- ------ <br /> REVIEWED BY------------------------------------ ------ DATE-�f ---�-`----S---------------- <br /> BUILDING PERMIT ISSUED - --------------------------------------"-"-•---------------------------------------- DATE.-------------••---•------- --------------------------------- 1 <br /> Alterations and/or recommendations:------- -- --------------- ---- --- ------------------------------------------------ -----------•----------------------- <br /> --•.---•--•--------------------•--------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------ <br /> ----------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------- <br /> ---------------- <br /> FINAL INSPECTION BY:-- .. �r� ------------- Date.-----t- �` `� �` --------------------------•---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stock+on, California Lodi, California Manteca, California Tracy, California <br /> E5-4-2m 195446 AT-D 12-54 <br />