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APPLICATION FOR-SANITATION PERMIT <br /> T i <br /> l <br /> (Compete n Duplicate) �/ <br /> .. 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 County Prdinance No. 549• <br /> JOB ADDRESS AND LOCATION -1B&4RCher'akee_Lane <br /> A,L- T mmell ---- ---- Phone------------------------------------k . <br /> } Owner's Name ' <br /> Address-----------SAM:P-------. ----- --------------------------------------••------------------------- = <br /> Contractor's Name_A_.L _TY`mmtae11--------------------------------------------------------------------------------------------------------- Phone-----------------------------: <br /> Installation will serve: Residence ❑ Apartment. House ❑ Commercial ❑ Trailer Court :] ,Motel ❑ Other ❑ , <br /> Number of,living units: -7____ Number of bedrooms -------- Number of baths _2__ Lot size -----." ` __�GI'C----------------________ <br /> Water Supply: Public system ❑ Community system,'D Private PR Depth to Water Table _______ ft. ; <br /> Character.of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [IClay Loam E] Clay E] Adobe[37 Hardpan E!"\1 <br /> Previous Application Made: Yes [:] No EX New Construction: Yes ® El <br /> �\ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �. <br /> (No septic,tank or cesspool permitted if public sewer is available within 200 feet.) `.. <br /> s -- <br /> Sep�t�Tank: Distance from nearest well_________________Distance from foundation__________________.Materia!___________-___.______.-________- -__ .___ <br /> KL-A-tin p Size----------------------- --------Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: s Distance from nearest well <br /> - F <br /> � , No. of com artments__ _ _______ <br /> ` � �.Q�__-._Distance from foundation---------10t--.Distance to nearest lot line__!_1------- <br /> Number <br /> _-____Number of lines---------1--------„-------------Length of each line----------25 t-----------Width of trench-----------20__--------- _ <br /> Type of filter material----.14R0_ck---Depth of filter material------I$n_-___.._Total length__-___-____.25 <br /> Seepage .Pit: pistance to'_nearest well___105_!-------Distance from foundation_____-15_..------Distan�e to nearest lot line----- <br /> ® : Number of pits__________I_________Lining material---HrlG}-____Size: Diameter______!�B___-------Depth------------25_______________ <br /> Cesspool: Disfance from nearest well-----------------Distance from foundation_.------------------Lining material-------------------------------------- <br /> 171 .'Size: Diameter-------------------------------------Depth_-_----------------- -_----------------------------Liquid Capacity---------------------------gals <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> ElDistance to nearest lot line------------------------------------------ ------ -------------------------------•------------------------------------------------------- <br /> Remodeling and/or repairing (describe):---------------Remadeli il',_------------- - --------•-------------------------------------.---------------------- -------------- <br /> -----------------­­ r <br /> -,'..______________ ------------------------------------------------- ---.-_-____-___-__________-_-_____.___-______________-_________________----___-____---- <br /> -J______------------------- <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with-San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) A �+�T '8II11I1 ----------------------------------------------------------------------------------•------------- <br /> (Owner and/or Contractor) <br /> ------------- Title-----Oxner--------------------------------------------- <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____ 7.L �"�--- - =-------------- <br /> ------- - --- ------------ -- <br /> ` REVIEWED BY--------------=---------------------- ---------------- ----------------- - ------------------- ---------------------- - DATE--------------------------------------------------------•-- <br /> BUILDINGPERMIT ISSUED__--------=--------------------- ------------------------------------------------------------------ DATE---------------------------------------------- —r <br /> Alterations and/or recommendations------------- ------------------------------------------- ----------------------------- <br /> 1 ------------------------------------- �_ � �� F <br /> De ------- <br /> ------------------- - <br /> U ---- <br /> ----------------- ------------------------------- --------- <br /> ________________ _____________________ -- k <br /> 1 FINAL INSPECTION BY------------------ ------- Date ----------------------------------------- . <br /> SAN ;IOAQUIN LOCAL HEALTH DISTRICT <br /> r 130 South American Street 300 West Oak Street I32 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES--9-2M 8-51 Revised W-2100 4 - -111L:� <br />