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r ►` <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...Ct.P. 2- <br /> (Complete in Duplicate) <br /> Date.Issued <br /> •�` d <br /> Applica4ion 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 Ordinance No. 549.. <br /> ti <br /> JOB ADDRESS AND LOCATION-- _ - .7-------- `--- - - ec.ItL--_. -II �CGs �/ 3 IIir1 <br /> Owner's Name - `5 .5 = Phone------------l�I .C ' <br /> --- --------- <br /> Address-------------------_--------------- = 7 --------��` � i-L am_!!4J � �l�N - ` <br /> Contractor's Name----------------------------------------- _. _:/_G. Phone. <br /> ----------------- _ <br /> Installation will serve: Residence }Apartment House E] Commercial E] Trailer Court C] Motel [) Other E]Number of living units: ___ .. Number of bedrooms __�--Number of baths _1---- Lot size -------- <br /> Watery ❑"'Community system.❑]Private Depth to Water Table ft, <br /> Water Supply: Public system <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay,Loam ❑ Clay [] Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ .No 0 New 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 /> Se ti .Tank: Distance from nearest well.,-J�----Distan,cf,�from foundation_:2_U--.------ma$efiai.................-1 <br /> p 1Z------- ---Size.. t 4.---------Liquid depth------- ----- Capacity- 4?0a <br /> d No, of com artments.._.___ <br /> . �..k ' <br /> al Field: Distance from nearest well__.��--------.-Distance rom foundation .-__.Distance to nearest lot lin ------- <br /> Number <br /> ---_.Number of lines------ �-Length of each line----------6d_. ----...W'idth of trench-------��---6----------- <br /> +s os 12 C� . <br /> Type of filter material..- tSd Depth of filter material_____--. --.--._Total length------------------------------------------ <br /> Seepage Pit:.' .x Distance to nearest well._._-----_-- -------Distance from foundation-------------------.Distance to nearest lot line------ <br /> ._-.❑El' <br /> ' Number of pits----------------------Lining mater ial--.__--------.-------..Size: Diameter------------------.----Depth-------------------------=---- <br /> -- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material ._.___---___----------._---._--. <br /> ❑ Size: Diameter-------------------=--------------- Depth-. ---=------------------------ -------------Liquid Capacity- --------------------------gals. NI <br /> Privy: t Distance from nearest well ..................:. .I--------------------.-Distance from nearest building_---------.-_____._---_-_ <br /> 0 i �"Distance to nearest lot line----_'-..._-____`..-_...............;:..-_ T r_ <br /> ------------------------------------- ------------------------------ <br /> Remodeling and/or repairing (describe)---------- ---------------------------- -------------•------------= _ <br /> --•-•---------------------------------•----------------•-------------------•---------------------------------------------------------------------•-------------------------------- ---------•.-•--------- <br /> ------•-------•----------• ----------------------------------------------- -­---------------------- ---•-•-•- .. <br /> - -----------•-•-------------------------- <br /> --------------------------------- ---------------•--------•-------•---•----------------------------------------......-------------------------------------------------------------------- ---- i <br /> I hereby certify that l have prepared this application and that the work will be-done in accordance with San Joaquin COuiii;•_, <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. t <br /> 5i ned ----.-----._--.-._-(Owner and/or Contractor)By:------?---S v ------------------------------------- ----------------(Title)----------------------------------------------- ---------------=—•g- <br /> (Plot plan, showing sizeof lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), a <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.---- - -- ---------"---------------------------------- DATE------ k <br /> REVIEWED BY-------------------------- -- - ----- ----- --- --------- - <br /> -------------------- --- ----- DATE------ - ---------••------ <br /> BUILDING PERMIT ISSUED------------------ - -------------- -------- --------------------------------- -••--------------- DATE..--- •-------------------- <br /> Alterations and/or recommendations:. ------------------ ------ -----------------------------------------------------------...------ <br /> ----------- <br /> -------------­------------- <br /> ------------- <br /> =------------------------------------------------------------------------------------------------------------------------------------•-------- r <br /> -•---------------------------•- -------.---------•---------------------------------------­----- ------------------------------------------------ - '.... _ <br /> ------•--•-------------•------------ ----------- ---- <br /> � . <br /> FINAL fNSPECTION BY::. Date - <br /> .. <br /> -3) <br /> SAN JOAQUIN LOCAL HEALTH DISTR <br /> 130 South American Street 300 West Oak Street 132 Sycemor treat 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9 14544E ATWO0D <br />