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` k <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._ `. . _... <br /> r' (Complete in Duplicate) <br /> Date. Issued <br /> Applica+ion is hereby "made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliance,with County Ordinance No 49. `- <br /> JOB,ADDRESS AND L ION--------/--. /---------a-------- ------ ` " ----- ---------•------------------------•-•----- <br /> ---- Phone..�7i <br /> r <br /> Owners Name----•---•-f----- -- --•-------• ----- - ----� -•------------------ � <br /> Address--------/ G( ------ •---- ... ..-. <br /> Phon - <br /> Contractor's Name...........----------------- - --------------- •----------------------•-------------------- <br /> ---�-�---- • --� --- <br /> Installation will serve: Residencet�Apartment House ❑ Commercial ❑ Trailer Court .❑ Motel ❑ Other ❑ <br /> Number of living units: _--/---Nu. <br /> -- Number_of bedrooms -- .- Number of baths __/__ Lot size _-:-.�G�_X ��-�--�---------------- <br /> Water Supply: Public system Communmsµ_ ity system;❑ Private ❑ Depth to.Water.Table-91-- ft. _. <br /> Character of soil to a depth of 3 feet::.Sand ❑ Gravel n Sandy Loam ❑. Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [J� New Construction: Yes ❑" No [B— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 4Disposal[ <br /> tic Tank: Distance from nearest well-_----.---__----Distance from foundation---- -------------.Material_-._--.._---.--.-- _---_--_---.-_---.--._.. <br /> No. of compartments- ---------< Size--------------------------------Liquid clepth-;---- ------------------.Capacity-----------•-------- - <br /> fiieid: Distance from nearest well...----------- Distance from foundation-----------------.-.Distance to nearest lot line------------__--. <br /> Number of lines------------------------------------Length of each line------------ Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth•df filter material-------------------------Total length-------------.---------------------------- \ <br /> /, <br /> Seepage Pit: Distance to nearest well/�_&�-Distance m fo dation---��---- ..Distance to nearest lot line--K47 <br /> Nu -mber of its---- -------Linin material-- .Size: Diameter_- 3��. ..._-Depth ,P�-S._ <br /> nce from foundation.-.--- _ <br /> ------.Lining material__..- ------ --------------------- <br /> Cesspool: Distance from nearest well____.__-..____--Dista❑ Size:Diameter-----------•----- - ------Depth--------------------- --------- ------.Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building°.`___--_--------_--_____-_--.----------. <br /> ❑ Distance to nearest lof line ---------------------------------�-------•---------------------- - <br /> Remodelingand/or"repairing (describe):---------------------------------------------------------------------------------------------------- -------------....-••------------------•------------•--- <br /> -------------------------------------------------------- <br /> ---------------------—-••p-----•--•---------- --------------------...-------------------------------------------------------------------------------•--------------- County I herebyc that I have prepared Ais•a lication and that the work will be done in accordance with San Joaquin <br /> ordinances, S t �AA <br /> , and rul and regulations of the San Joaquin Local Health District.. <br /> `---- - --- ------------------ ------'----------------- -------- -----­---------------------------- <br /> (Signed) ner and/or' Contractor) <br /> bwos <br /> ----------•-- ------ <br /> .C��------: (Title] { <br /> BY: �_-----•----------------=--------------- <br /> (Plot plan, showing size of lot, ocation of system in relation to ells, buildings, etc., can be placed on reverse side). } <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------------- ------ ------------------------------------= _.___.:.--------- DATE------/-- ----- -------------------------------- <br /> REVIEWEDBY----------------------- -:------------------- ---------------- --------------------------------- DATE--------- -,-------------------------_------------- <br /> BUILDING PERMIT ISSUED---------------- ---------- - DATE-- -- -----------------------------------•---- <br /> Alterations and/or recommendations:-.------`----------_. -••- ----------------- <br /> ----------------------• --------------------- <br /> -- ----- <br /> L = - - � <br /> ----------------------------------------- ------------------ <br /> ------------------------------------------------------------ -------- -------- <br /> ------------•--- ----------------- ----------------- --- ----- ------------------------------------------------ <br /> —Date.--.f- r ` <br /> FINAL INSPECTION" BY------------------`_-• ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street <br /> Stock+on, California Lodi, California Manteca, California Tracy, California <br /> ES-9 145446 ATw000 •y <br />