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�y\ APPLICATION FOR SANITATION PERMIT Permit No- -------- ___.,__-_-- <br /> (Complete in Duplicate) /(! <br /> 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 with County Ordinance No 549. <br /> JOB ADDRESS AN OC ION__ _______ __ ___:I!__.--.-- -' ""' --- <br /> l(O <br /> Owner's Name----------- ------- ----------- ----• ---•---- ----• --- - / Phon --------43,3 -S--- <br /> Address --.. ........ 8 = A- ---------------•------- -------------------------- <br /> �tt , - . r~ o X16 <br /> Contractor's Name----- Ci- -Ve. --JA,. ......... :� l-- --- � ------------•----- ------ Phone-- ------------------------------ <br /> - <br /> Installation will serve: Residence r Apartment House ❑ Commercial ❑ Traililer�ourt ❑ Motel E] Other E]Number of living units: __..I- Number of bedrooms _Number of baths __"_Y Lot size ------- -._ <br /> * •y <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table hof <br /> ft. <br /> Character of soil to a depth of 3 fee+: Sand Gravel ❑ Sandy Loam ❑ Clay Loa ❑ Clay ❑ Adobe 2ardpan ❑ <br /> Previous Application Made: Yes � ew Construction: Yes ❑ No [ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic nk or cesspool permitted if public sewer is available within 200 feet.) <br /> Se c Distance from nearest well-----------------Distance from foundation-----------------__Material _._____._______.__.___._._____----__-__-_--... „ <br /> No. of compartments-------------- Size -- LiGoid ------- -- -----= -Capacity----------------------- <br /> osa Distance from nearest well._____________ Distance from foundation--------------------Distance to nearest lot line____-___-___--_-_ <br /> Number of lines-----------------------------------Length of each line---- <br /> --------------------Width of trench--------------_-.__ <br /> Type of filter material______ __Depth of filter material________ _____ J Total length_____________________._______________._-_ <br /> ----- <br /> See it: Distance:to nearest well_____ ________________Distant o oundation__` V____- Dista ce to nearest lot kine___ _ <br /> ff ., f _ <br /> Number of pits.-.___�[--------------Lining material.__-_..._ Size: Diameter__-__,�?�_0____Deptn_._._��_._-------------- <br /> /It <br /> ------- ---- \ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-- -----------------Lining material------------__.____.______-_______. <br /> ❑. Size: Diameter--------------------------------------Depth----------------------------- ---------------------Liquid Capacity -----------------�-gals. <br /> I Privy: Distance from nearest well----------------------.-------------------------Distance from nearest building----------------------------------------- <br /> Distance <br /> ---------------------- ----_Distance to nearest lot line___---------------------------- -------------------------- <br /> Remodeling and/orirepairing (describe):...............-------------------------------•-----------------------------------------------•--------•-----•---•----•-----------------------•-------- <br /> --------- - •---------- ------ --- -------------------------------•------•-----------------------------------•-----------••-•----------••-------------- -----------------•-••---------------•------------•--•---------------- <br /> I hereby certify+hat I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rula� 1&rNtbAins of the San Joaqu' Loc I Healt District. <br /> s , ._ a, <br /> Septic Tank Service - - ontract <br /> .•-- -- -- ---- -- <br /> (Signed).• _------­----------- <br /> - - 'fZQb3o:-Eldovada----Nfl-2-�0�41r--------- ---- - - - �� <br /> ----- ----------�tocktnn,_Caiif.--------------------- -------- ---------------- ---------- ..._Title <br /> (Plot plan, 'showing size of lot. location of system in relation to Is, buildings, etc can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------- ^��� <br /> -----------------------------------------• -------- DATE------�------------- --------------------------------- <br /> REVIEWED <br /> - -- -------------------------- <br /> REVIEWEDBY----- -------------------------- ----- -- ------------ -----------•-------------. ------------ DATE---------- ..� <br /> BUILDINGPERMIT ISSUED------------ --------------- -------- ------------------------------------------------- DATE..---- �..-.....I - ----- ---- - <br /> Altera+ions and/or recommendations:---------- ---- ------- � - -� <br /> ----------•------- r ---- sr ! !1 ------------------------------ ---------------------------••---•--- ----------------•---- <br /> /ul <br /> y <br /> ------------------------------- <br /> ----------------------r ----------- ----------------- --------------------------------------------------------------------------------- - <br /> ---------------•----------------------------------------- ---•-- --- - ------- ---------- <br /> FINALINSPECTION BY:-- -------- ---------__------------- Date------------------------------------------------ --------••------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145445 ATWUUD 12-54 <br />