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K <br /> APPLICATION FOR SANITATION PERMIT Permit No. _.._�__f�.._.r.'__.. <br /> (Complete in Duplicate) ; � ;� <br /> Date Issued _�_�___ -_____-__, <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. 549. <br /> rfa L <br /> JOB ADDRESS AND OCATION-- ---------------v4 - `/ �. c a o� . I _)- -------- ------- <br /> Owner's Name.... -- - -_----- Phone <br /> Address-------------------_ -----------•-•--------- ------------------------ --------------------------------_- .......- - ------ - -- <br /> ------- --•- ------------------- <br /> Contractor's Name__.-{:/�---jF----N-,f-L --- Phone. 'v � <br /> Installation will serve: Residence ❑. Apartment House ❑ Commercial ❑ Trailer Court [ Motel ❑ Other ❑t <br /> Number of living units:-?'. Number of bedrooms _______ Number of baths -------- Lot size -----*------------ <br /> Water Supply. Public system ❑ Community system ❑ Private ❑ Depth to Water Table t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> flAo septic tank or cesspool permitted if public sewer is available within 200 feet.f- <br /> Se is Ta Distance from nearest well__,_______________Distance from foundation------------.------Material______._____.______________•._____-_-.._-_-._-. <br /> No. of compartments--------------------------Size---------------------------•---Liquid depth.------- Capacity------•------____ <br /> sa Distance from nearest well-.__-_•____...._Distance from foundation--------_-----------Distance to nearest lot line________________. <br /> Number of lines-----------------------------------Length of each line---------------.-----------.-.Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length---.-------------------------------------- <br /> I ! <br /> Seepage Pit: Distance to nearest well_-y-. G_____Distanc om foundation__/4___._..___.Di t ce t� i <br /> ®� Number of pits 1� Lining material_ j-_-_._..Size: Diameter_-_ ----Depth----- <br /> �� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___________.__.--- Lining materi _-.-?""*�L+�_'_. <br /> ❑ Size: Diameter--------------------------------------Depth--------------------•----------- ------Liquid Capacity----------------------------gal <br /> Privy: Distance from nearest well _.________________________________Distance from nearest building_.________.__._______________._________. <br /> ❑ Distance to nearest lot line---_--------------------------------- ----- - -----------••-•----•--------------------------------------------- ---•-- •---- ------ <br /> Remodeling and/or repairing (describe):__..l�- r+�-�V __ dtnto "� <br /> -----------•------------------------------------••-----•---•-•------------•-••----•--------------------------•---------------------•-•-•---------------------------- ----------------•-•-- .--. <br /> --------------------------------------------------------------•----------•--------------------------.--------------------------------------------------------------------------------------------------- -------- <br /> I hereby certify tha+ I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and ru�ggs ap�rpgalatinns of the San Joaquin Local Health District. <br /> Sege x.tr�: a- <br /> (Signed}----- r, ;� ': :ar: _K0-2-7CL4=---------- ---------- ------ ----- --- �or Contractor) <br /> Si4C1<tonx_Calif. - Title <br /> {Plot plan, showing size of lot, location of system in relation to w s, buildings, a ., can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY .----------------------- - - ------------------ -------------------•------ ------ DATE c'.-�R--"------------------------------------------------- <br /> REVIEWED BY-------------------------- *— - DATE__.-------------------------------------------•------- <br /> i3UlLDING PERMIT ISSUED - _ - DATE.. %, - -------------------- <br /> Alterationsand/or recommendations:------------------------ ------- --------- ------------------------------------------------------------cr--------------------------------------------------- <br /> ---•--------------••------------------------ ------------------------- ----------------------•-------------------------------------------------------------•------------------------------------ <br /> ---------- ----------------- ----------------•--------------------------•------------ --------------------------- -----------.----•---•-•.--------------------•------------------------•-••----------- <br /> ------------------ ---------------------------•--------------------- ----------- ---------------------------------------------------------------- -----------.----•---------------------------------- <br /> -----------------------•- ------------------ --------------------------- ----- -------------------------------- ------------------------------•---------------------------------------------------------•-----•--•---•-•-- <br /> R <br /> FINAL INSPECTION BY:----. - -!,!-�4 -* Date---Q.__ ')-'�__r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> r9-9-2m 145446 ATWOOP 1Z-54 <br />