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N, <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued .__./1_ <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 Ordinance No. 549. <br />' JOB ADDRESS AND LOCATION-- <br /> Owner's <br /> ------- <br /> p. o c�-. .-.}_d.----_-- -------------------•------------------------------------------- <br /> Owner's Name-----c- 1 ----------1' ?ji_-m-.?,tea Ci -----•------------------- - ----------------------- ---.-- Phone--------------------•--------------- <br /> Address.-----------•- - -- ----------- ------------ ---------••-------------------------- �/ <br /> Contractor's Name.__D.. �. �d-(i-hl. G' Phone._LI_Q-----{ ria <br /> -- G R! --------�" . <br /> Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1.----- Number of bedrooms ____L Number of baths ----!._ Lot size ----3__7---A--11 A---------------------------- <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(4 Hardpan ❑ <br /> Previous Application Made: Yes ❑ No %L New Construction: Yes ❑ No E� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: isfance from nearest well _Distance from foundation__._-____________.Material------:_____.___---_-____._____________..___---. <br /> ❑ dg�bf compartments--- -- ------------------Size--------------------------------Liquid depth-------------------------Capacity...-------------------- <br /> r <br /> Disposal Field: " Distance from nearest well----: ----Distance from foundation________ __ _ <br /> Distance to nearest lot line _.____ <br /> ❑ lu ber of lines---------------- ------------------Length of each line--------------------- - ----.Width sof trench----------------------------------- <br /> Tye of filter material_.......................Depth of filter material------.----------------Total le.ngth___._---________-___________-------------- <br /> Seepage Pit: Distance to nearest well---:__ e)---___._._Distance from nnfo�u�nc,ipter�ion----�-0---------DistanF to nearest lot lirrje__._s�.._____ <br /> -Linin material__. --ISS J size: Diameter----5_-----------Depth__,P$7-- --------------- <br /> Number of pits_-..___/___.____ -,- g <br /> Cesspool: Distance from nearest well-----------------Distance from foundation..._.--------------Lining material--------- -------------------------__. <br /> F1 Size; Diameter------------- --------- ----.Depth-------------------------------- ------Liquid Capacity----------- ---------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-------------------------.--------------- <br /> ❑ Distance to nearest lot line-- ------- ---------------•------------------- -----•--------------- <br /> Remodeling and/or repairing (describe)---------------------- ----- -------------------------------------------------------- -----•-----------•------------------------•-----..-•-- <br /> ---------••-------•------•-------- <br /> •-------------------•-------------•-----------------.---•-----•-------------••---------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ________________Owner and/or Contractor) <br /> {signed)------- / "f. t { <br /> _ tS ------------------------------------(Title)---- --- ----- <br /> ----- <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------------------- --------------------------- DAT <br /> REVIEWED BY----------------------------------------- _ DAT -- _ <br /> DATE-------- -- <br /> BUILDING PERMIT ISSUED------------ ---= -�---------------------- <br /> Alterations and/or recommendations: ----- --------------------------------------•----------------------•-----------------------------•- '--•-•----------- <br /> ------------------ ------------------------------------------------- <br /> ---------- ------------ <br /> 1 <br /> FINAL INSPECTION BY: Date j <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 t45446 ATWDIID 12-54 <br />