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II �j <br /> APPLICATION FOR SANITATION PERMIT Permit No. ___.�.�-V. <br /> (Complete in Duplicate) <br /> Date Issued _1011._TY___ <br /> Applica+ion 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 Ord'n c -No. 549. <br /> JOB ADDRESS A�p LOCATION ! __v; -------------- --------------- 4i_,�--------------------------------------------------------------- <br /> ----------------------------- <br /> Owner's Name.. . :-E' - -- --- ------=----------------------------------- - - - - - -- •-------------------- ------ Phone------------------------------------ <br /> r_� <br /> Address-- ----- <br /> --- <br /> ._.. <br /> — <br /> - ---------------------- -------------------•----------------- ------ -- - ---------- _ <br /> Contractor's Name ff•.-- - ---- <br /> r Phone.`� 2' <br /> Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_[_ Number of bedrooms .__Number of baths -/---- Lot size __ c%-----7C---!----Zs _ __________________ <br /> Water Supply. Public system Community system ❑ Private ❑ Depth to Wafer Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ar pan ❑ <br /> Previous Application Made: Yes ❑ No [§—New Construction: Yes ❑ No F —_-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank: Distance from nearest Distance from foundation_J_6__11.----.Material _-- - ________________--_---____. <br /> No. of compartments----- - ..,,------------Size___y _X___�1.___Liquid depth--- capacity <br /> Disposal Field: Distance from nearest wells'Yw-. _Distance from foundation ff- --_.._.Distance to nearest lot line._/'p_....... <br /> [ � Number of lines ----------------Length of each line_ `,. Width of french --- <br /> -"_.__-__.________.__ <br /> I Type of filter material-- ______________Depth of filter material__�_/_ G'_._Total length-------- _ =-_' ________._______.._ <br /> Seepage Pit: Distance to nearest welk-2-1.—-------Distance from foundation__ Distance to nearest lot line__ —�.__._- -OW <br /> Number of pits...... .............Lining material_ _- '_.__.Size: Diameter___ .`_._ Depth_._ .,---.__!__-____.__.__.__� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material-_.---__.___-______.__.______-_-_--_- <br /> ❑ Size: Diameter--------------- ------- -------Depth--------- ------------------------------------------Liquid Capacity--------- ------- ---------gals. <br /> .. �.� <br /> Privy: Distance from nearest well __..-_________________v..-------------- ------Distance from nearest building_=__._.__--__------__----------------.._.� <br /> ❑ Distance to nearest lot lire- ------ -------- -------- --------------------------------------------- -------- ---- <br /> Remodeling and/or repairing (describe):------ ---------------- ------------- --------_----_-•--------------------------------- <br /> ---------------------------------------------- -----------------------------------------------------------------------------------------------.-------------------------------------------------------------- - <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, to laws, and rules and regulations of the San Joaquin Local Health District. <br /> P <br /> (SignedB)-Y--- -_ --------------------------------- ( an or Contractor)- --- ---------------- <br /> -- -- -------- (Ttle)------------- ----------------------- <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 /> [f� --------------- <br /> APPLICATION ACCEPTED BY......................... DATE--____.__.__.__ . <br /> � �¢ <br /> REVIEWEDBY------------------------------------------------------------------- ------------------- ------- --------------------------- DATE------ ----•--------------------- <br /> BUILDING PERMIT ISSUED------------------------------- ------------------- ------ -------------•---------- -----------._ DATE.----------------------------- ------------------ <br /> Alterations and/or recommendations-- -------- -------------- ------ ----------------------------------------------------------------------•-----------•----------------------------------------- <br /> --------------•---••------.--- ••-----------------------------•------------------------•----------•----------•--------•-------•-------•---- -•--------••------•--•-•-•---------------------•------ <br /> ------------------•-------------------------------------------------------------------.-------------------------------------.--------------------- -----------­---------- --------------- --•---- ------------------- <br /> -------------- ------------ - ------ - <br /> ------------------------------------•-•----------------------- -•---— ------- - - <br /> I/W.-.4, I� rM /&,) -11// <br /> fJ� <br /> FINAL INSPECTION BY------------------ -------------------------------------------- Date.------------------------------------------------------------------------•------ <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2M x95456 Ar Wpdo 1Z-54 <br />