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` Permit No. � _..-7----�``�-----• <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) ,aG� 1 Date Issuedr' 573 <br /> Y <br /> Application is hereby made to the San Joaquin Local Health <br /> District <br /> for <br /> o a permit to co ruct nd install the work herein described. <br /> This application is made in compliance with County <br /> � � vw--------------- -------------------------------------------------------- <br /> JOB ADDRESS AND LOCATION._ Phone------------------------------------ <br /> Owner's <br /> ------ "Owner's Name----------------•- �J1J r� <br /> Address <br /> -- = _ t <br /> -------- - •-------•-=-`-t-------- " Phone------------•----------•---•--•---- <br /> - -- - ------------------------------ -- <br /> --------------------------- -- p <br /> Contractor's Ns�e.-----...�------------------ � # � Motel k. Other ❑ <br /> Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court❑� <br /> f <br /> Number o.f living units: _ _ Number of bedrooms --2— Number Number of baths __�_._ Lot size _____ l <br /> ) Community s stem ❑ Private,] Depth to Water Table -------- ft. <br /> Water Sf ppiy: f public system ❑ Y Y - - - Cla Adobe ' Hardpan ❑ <br /> Gravel Sandy.Loam ❑ Clay Loam ❑ Y❑ <br /> Character of sail #o a depth of 3 feet: Sand ❑ 0-� <br /> previous'Application Made: Yes ❑ No® New Constr=coon: Yes No El <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or esspool permitted if public sewer is available within 200'feet.) -"-- --- / { <br /> d--�tJ 11 <br /> Distance from foundation_,-/P--------Mate I ---- y- -- - - r <br /> Septic Tank: Distance from nearest well-�Q_Q- - ,0( - -Capacity___ <br /> No. of compartments---------� ---------5ize__ Q_ - _ __ ----Liquid dept,____.-f----- .. <br /> t Distance from foundation d `_-.Distance to nearest lot line___--1J___--___- <br /> -- <br /> I D,'�-U j_a Q Width of trench _�.--------------- <br /> Disposal Field: Distan-e from nearest welL_h(,?__-�'. <br /> Number of lines------- -------. "--"--- Length of each line-- i <br /> - `•�-,_Total len th_-------��Q-------•--------- <br /> Type of filter material---�cAP��--Depth of filter material----- pis}ar�ce go nearest lot line_________________ <br /> ! Seepage Pit: Distance to nearest well _____Distance from foundation :__.___"___._____. <br /> Linin material-----------------------Size: Diameter---------- --------�--Dep t�n <br /> ❑ Number of pits------------------ -- g <br /> from foundation Lining <br /> material <br /> ------------------------------------- <br /> Cesspool: <br /> ____ _ _______ ____Cesspool: Distance from nearest well_________________Distance <br /> gals <br /> quid Capacity <br /> Size: Diameter--------------------------------------Depth--------------------- <br /> ❑ . <br /> ! Distance from nearesi building----- - - --------------------------- w <br /> Privy: Distance from nearest well--------------- <br /> ❑ Distance to nearest lot line._----.---------- <br /> ------------------------ <br /> I -------•---•----------"----•----------"-----------------"-------•------------------------------- <br /> Remodeling and/or, repairing (describe)------------------------ - -•-------------_-------------- <br /> -----------------------•-------•------- <br /> - ------------------------- ---------•------- <br /> h <br /> I hereby certify that I have prepared <br /> application <br /> the San JoatluinLocalkHeallth D tr o}n accordance with San Joaquin County <br /> ------ -- <br /> ordinances, State laws, and rulesregulations <br /> t_,,,,...�. .. . �� _�..� � (Owner and/or Contractor) <br /> ------- f -_ <br /> 1 1Signed]. ---- ------------------------------ ----------- ---- <br /> Tale <br /> ----=-------------------- ( ) <br /> t on reverse side). <br /> (Plot plan, showing size of lot, location of systetnin relation to wells, buildings, a#c., can be placed <br /> FOR DEPARTMENT USt= ONLY <br /> Ar <br /> �. <br /> APPLICATION ACCEPTED BY--_____ .---�--- <br /> ------. ----'.DATE----- --- r-" =�= <br /> ' REVIEWED BY <br /> ----- <br /> --------------------------- DATE <br /> ---- - DATE_.-----�---------'=------`--'---------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------- -----------------------------------�---------------- ------------- -----•-----•--------------------------------------- <br /> Alterations and/or recommendations-------------------------------- ----- <br /> ---- �--- , <br /> ----------------------------- <br /> ----------------------------------------------------- <br /> __________________ l - 54x <br /> - <br /> ------------------------------------------ <br /> Dater -- <br /> FINAL INSPECTION BY--------------- -- ----- ---------------------- ---- ------- -------------- <br /> (/ --- s- -- --- <br /> 5 y, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> l32 Sycamore Street $14 North "C" Street <br /> 130 South American Street 300 West Oak Street Tracy, California <br /> Stockton, California <br /> Lodi, California Manteca, California <br /> ES-9-2M 10-52 Revised W-2100 <br />