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APPLICATION FOR SANITATION PERMIT Permit No. -.1)AL <br /> (Complete in Duplicate) Date Issued <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 twith County Ordinance No. 549. At e a- 4' <br /> fe Io Al <br /> JOB ADDRESS AND LOCATION- ------A <br /> Owner's Name--------------- 4----- ----I------ <br /> Phone. <br /> --•--- <br /> Address <br /> hone- ------ <br /> Address /01A,___ . .. ..... <br /> )ed�_ t (.-_..C_- -�_ _e------ a <br /> _ �.......... ............. --------------------------------------------------------- <br /> Contractor's Name----------------- --------------------------------------------------------- ------ -----•---------•-----•-------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence 2-0-Apartment House 0 Commercial [] Trailer Court E] Motel E] Other E] <br /> e <br /> Number of living units: ---- Number of bedrooms ---L- Number of baths ---L Lot size ------------------ <br /> Water S6pply: Public system El Community system [] Private B'Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam 21"'Clay Loam 0 Clay E] Adobe E] Hardpan 0 <br /> Previous Application Made: Yes El No 2` New Construction: Yes W-No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> o 0 <br /> jqation_,0__.-----------Material...A-4-4v <br /> Septic Tank. Distance from nearest well-0a - Distance from fours -- - ­--------------------------- <br /> No. of compartments-------2----------------- Liquid ........Capacity.... <br /> Disposal Field: Distance from nearest well-100........Distance from founclation-VA-A-----------Distance to nearest lot <br /> X Number of lines----- ___h-C....... ------ __Length of each line----- ----------Width of trench.__A��_>11 11--------- -------- <br /> 0 ep of filter maferial----_/9"----- -Total length....___ ----------------------- 4 <br /> Type of fifter maferial.__S­1A._.&-k_D th <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line._-_---__________ j <br /> ❑ <br /> ine----------------- <br /> El Number of pits_-------------------Lining material-----------------------Size: Diameter----.------------------Depth--------- ----------------------- <br /> Cesspool: Distance from nearest well-------- --------Distance from foundation--------------------Lining maferial---------- ------- ------__---------- <br /> --- --- ------ ......�..Dep h- .--- _::T=Liquid-Gapac-it y__..------------------------ also <br /> Privy: Distance from nearest we].--------_--------------------------------------Distance from nearest building_____________.________________._____.____. <br /> ❑ <br /> uilding------------------------------------------ <br /> F1Distance to nearest lot line--------- -------------------•------------- --- -----_-------------------- -------------------------------------------------------------- 4� <br /> Remodelingand/or repairing (describe)----------- ----------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------I--------------------- -----------­---­--------- ...............I----------------I----------------------------------------------- <br /> --------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------I---------------- ------------------------ <br /> I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County <br /> ordinances, State la�.--- <br /> d ruled re:! ulations of the San Joaquin Local Health District. <br /> Signed)-------------------- ---I--------- <br /> ( - ........-------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------------------------------------------------------(Tif le)------------------------------------------ ------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F R-DEPARTMENTE ONLY <br /> W <br /> _ ------------------- <br /> APPLICATION ACCEPTED BY ---------- DATE------ -- x- <br /> --- - - <br /> REVIEWEDBY------------------------------------ ---- ---------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------- ------------__---------------- DATE----- ----------------------------------------------------- <br /> Alterations and/or recommendations:--------------------------------- ------------------------------------------------------------------------------7-----------------­--­*------- <br /> ------------------------------------------------------------------------- ----------­­­-------------I--------------------------------------------------------------------------------------------------------------------- <br /> ----------I-------------------------------------------------------- -------------------------------------------------- ----------- ---------- ------------------- ----------------------------------------------------- <br /> ------------------------------------------------------------­-----------------­----------- -- --------------------------------------------------- • ---------------------------- ------------------------------------- <br /> ----------------------------- ------ ------------------ ------------- - ............. -------------- -------------------------------- ----------- ---------- --- ---------------------I-­--------------- <br /> - ---- --------------------------------------- <br /> FINAL INSPECTION ------------------ ----------- 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 /> -9-2M 145446-TWO13D 12-54 <br />