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APPLICATION FOR SANITATION PERMIT <br /> Permit No. 0-- -�--Y-- <br /> (Complete in Duplicate) <br /> -Date Issued /Q-^Cl..^_�_t/ <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 Ordinance No. <br /> 49. <br /> # <br /> JOBADDRESS AND LOCATION..----- -----_ �--------A---P-�-- co-------------------------------------------------- --- --------- <br /> Owner's Name_----- ,_ - ���-------------------------------------------------------------------------------------- Phone--- <br /> ------------------------ <br /> Address <br /> - <br /> -------------- - <br /> �(,� / -----------•---------------•--------------------------•------------------------------------ <br /> Address-------------14 -- ---'�'---------�----� Ad_�.•� Y/ ; .-. ------------ <br /> M 'a4 -------------------- Phone---- -� -- --- 4 <br /> Contractors Name---- ---• A-- <br /> Installation <br /> -Installation will serve: Residence jC Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other ❑ "` <br /> Number of living units: __2__ Number of bedrooms --- Number of baths _rhe-. Lot size -----���, - �_../-�-�------- -------------- y <br />$ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. ` <br /> Character of soil to a depth of 3 feet: . Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay [IAdobe S& Hardpan ❑ Q <br /> Previous Application Made: Yes ❑ No New Construction: Yes X Nod❑� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> +�'��'" _Distance from foundation-__-__1_Q_____.Material______-P_ -----• Q <br /> Septic Tank: Distance from nearest well_______________ <br /> No. of compartments---------�-----------Size-- Liquid depth--------- -------------Capacity--+lp �1 <br /> Disposal Field: Distance from nearest well---"`--------Distance from foundation____JU-------Distance to nearest lot line____ ...... <br /> Number of lines------------an-_________________ Length of each line____ -��-- -��---Width of trench______ _-__ . <br /> r+ ?.. ................. <br /> Type of filter materialIA__!_j i �epth of filter material______j_(�°________:-__Total length-------------z,xt�1'_—_--------------- <br /> Seepage Pit: Distance to nearest wbll------_---------------Distance from foundation---------------------Distance to nearest"lot line_______---_._____ <br /> ❑ Number of pits----------------------Lining material------_----------------Size: Diameter------------------------Dept h_----------------------- ------ <br /> Cesspooi: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------_---------------- <br /> . <br /> ❑ Sizer 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): ---------- ----- - -------------------------=----------------------------------------------------------------------------- <br /> --------- - ------ -- <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, anVrulan regulations of the San Joaqu Local Health District. <br /> - - --r-(Signed) ----------- --- - � ---------------------------------(Owner and/or Contractork <br /> By:------ --J --- ------------------------- <br /> -- -- --------------------------------------(Title)---------------------------------------------------------------- Y <br /> (Plot plan, showing si a Qf 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- -- <br /> > i/ ------------ ----------------- ---------- DATE-- --��----�--------------­------------------- <br /> REVIEWED BY------------------------------------------------ --------------------- ---- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------- -------- ---------------------------------- <br /> Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -- <br /> ----- -------------- -------------------------- -- ---------------------------------------------------------------------------- <br /> ------------------------------------------------ <br /> FINAL INSPECTION BY------------W---- ---- Date------------! f J7/------------- <br /> SAN <br /> ' --- ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 8I4 North "C" Street <br /> Stockton. California Lodi, California Manteca, California Tracy. California <br /> ES-9-2M 8-51 Revised W-2100 <br />