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APPLICATION.:.FOR..,SANITATION _PERMIT Permit No. ��.-�-.�.... <br /> (Complete in Duplicate) Date Issued <br /> t <br /> Applica�ion is hereby made +o 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 Name________ _ ___ ___ <br /> - Phone_ _._ �_� .� <br /> ' <br /> Address---- f ------ ---------- ---------------------------------------------------------••----------------------•- ---------------•-------•--- <br /> - = ----------- <br /> 7=70-1- Phone <br /> Contractor's Name____::___._ - <br /> -- ---- --- ;•ir:i F <br /> Installation will serve: Residence Apartment House ❑ Commercials [I Traiiller Court [j , Motel El Other El <br /> Number of living units% NNuumber,r of bedrooms N�mber6f boths _�l-___ Lbt size ---�S-���.�4-�--------------------- <br /> -'- <br /> Wafer Supply:- Public system [Community system ❑ Rriivate 0) Depth.tn Wate .Table y _ft. <br /> Character of soil to a depth of 3 feet: Sand ElGrav Gravel,[] Sldy`_Loam 0 Clay Lolm ❑ Clay ❑ Adobe 123'*Hardpan ❑ <br /> Previous Application Made: Yes 0 i. No [ New'Co struc ion..-. lie[�lo ❑ �. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> No se tic tank or cess ool-' ermitfed if public sewer i available within 200 feet.) <br /> etic Tank: P Distance from'nearest well______--r_------Dist nc from fob!afion�_______ ----- __Material____.-__----___________________--_._______-_-- <br /> p _ —. - �. _ <br />` l Field: Distance from nearest welle ___DistanceI-from founds#ion__�,Sipth__________________________Capacity_.....-________________ <br /> Nc. of com artmenl-s________________ _____ __Size________. ___ Li uid de <br /> Disposa/ ------------Distance to nearest lot line___. <br /> L7 .E } --- p � i� Uo-� ------Width of trench----O� y-------------------- <br /> TIN <br /> z Number of lines'�`_•"'�._____ _ _ `Len th of?each line______ �� ----------------- <br /> T e of filter inaterial_S�_ o--c,!<-_ __-De Depth of ?ilter material___-_-1�__!--_-__._T;otal length___-__ +�D_____________________________ <br /> --------- <br /> Type X. ) i, JI <br /> l Seepage Pit: Distance to neatest, ell___��7-_�''�-'__Distance from f undat^on___. .._____.Distar;�e to nearest lar line____---______-.. <br /> 'Number of pits_--_��_____._____Lining material�_Size: Di��er_____-3_a----...---.Depth__-._�_�_�-------------- <br /> i <br /> ________ ____ <br /> �. i <br /> Cesspool: Distance p rom nea'rest�well_______- Distancefrom foundation_____-____ _-- _.Lining material---_----_--------------------------- <br /> _ <br /> ❑ I------_Liquid Capacity--- ------------------------gals. <br /> Size: Diamet�er'.�'�------------�'- ---------=----Depth-------------------------------------------- <br /> 't Distance fro nearest building <br /> Distance .forret nearest well-N. g------------------------------------------ <br /> Privy:' Distance to nearest lot-line----= ----==--- <br /> m =' ---------- <br /> Remodeling`and/or repairing,; (describe):_._____________________ ______-__ <br /> ---------------------------- <br /> - �)nl.`-------------•----------------------------------- --------------------- -------------•---------------------..--------------------------------- <br /> ----------------------------------------------- = '---------- ------ -------------------------=------------------------------I-------`-- ------------------------------------------------------------------- <br /> l-here6y certify that I lav 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 /> ' `' - ----- <br /> (Signed)--' ----------- caner and/or Contractor] <br /> o <br /> BY� - �. - ------ --------------------------------------------(Title) c 9 <br /> t—� <br /> (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc.; can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------------------------------------------- -7- --------------------- DATE ; <br /> --------- -------- <br /> REVIEWEDBY-------------=----------------------------------------------------------------------------------------------- ----- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------------------- <br /> Alterationsand/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------- <br /> ----•---------•-•--•----•-••------------------------------- <br /> ----- ` ------------------ --------------•--------- --------------------------. ----------------- •----------------..... ---------------------------------------- <br /> -------------------- --------•--------- ------------------------------------------ <br /> FINAL <br /> ------------ <br /> - --------------------------------------------- -- <br /> ------ Date-------------- J S� /-• =--------------..-_..---------------•-•-- <br /> FINAL INSPECTION rBY:.._--_-i V-�._�_�-�-�- - ---------•---------- "}---�-- - - <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 /> ES-4-2M Revised W-2100 <br />