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APPLICATION FOR SANITATION PERMIT Permit Na=! 7"_ - __._' <br /> (Complete in Duplicate) <br /> ` Date Issued <br /> Application is hereby made to the San Joaquin Local Health Disfr'ict 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 LO ATION - - `-------------- -----------------.------------------------------------------------------ <br /> Owner's Name----- - L - Phone------------------------------------ <br /> k4 <br /> -- --_r_ ----- ------ -------------------------- -- <br /> Contractor's Name-----•- : - �`-1"_ _'" d '� -1 - - '�'" Phone-k- <br /> ---------- <br /> I <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel El ``Other E]Number of living units: I--- Number of bedrooms /--- Number of baths _,/___ Lot size _-__ '* ------------------- <br /> 'Water Supply: Public system Community,system..❑ Private ❑ Depth to,WaterTable.`__^aft. <br /> P <br /> Character of soil to a depth of 3 feet: 'Sarid Gravel ❑ Sandy Loam,❑ Clay.Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> a <br /> Previous Application Made: Yes E] No New Construction: Yes [ o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - <br /> (No septic tank or cesspool permitted if public sewer is available within 2011 feet.) <br /> Septic Tank: Distance from nearest well________________Distance from foundation <br /> #s___________------_Material_______-_:___________-___-__---------------_____. <br /> No. of compartments------------ ' -------------------------'1 ,Liquid depth---------------- ------._Capacity-------------------- <br /> 11 <br /> f =__'____Distance to nearest lot line__��___. <br /> Disposal Field- Distance from nearest ell/.i//�__ istance from foundation_ -__ <br /> Number of lines----- ------ ----- --- - Length 'of`eacli'line___.__ --___� ---Width of trench--- -------7 <br /> of filter material_- .Depth of filter mater.ial___.1__-___-_____Total length_______1__f�_o__________________- p0 <br /> Seepage Pit: Distance to nearest well-----,-----------------Distance from'foundation___________`_.___.Distance to nearest lot line----------------- Q <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------ ---Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-------------------------------------- <br /> 777 <br /> ❑��;� Size: Diameter Depth :.�: ---------------- ---- -_--Liquid Capacity------------ - ----gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distan6e frorrl nearest building_____________________________ <br /> Distance to nearest lot line_______________________ ; <br /> ❑ ----------------- ---- <br /> Remodeling and/or repairing (describe=------- -------- t : f <br /> y ------------- <br /> ---rr 'Cu�-�'l� `--- -------------- <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 t e San Joaquin Loc I Health District. <br /> 1 r� <br /> I(Si ; ------ -- - ----'- --- -'--- -- <br /> ----- -----------(O"n <br /> a nd/or ntractor <br /> gned)-------•- d ri - a ----------- <br /> By:-------------- --- --�---------------------------------------------------------(Title ' <br /> (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR•DEPARTMEW USE ONLY- <br /> y APPLICATION ACCEPTED BY-------------------------------- ----- DATE �� <br /> REVIEWEDBY----------------------------------------- ------------- --------------------------------------------------------------- DATE------------------------ --------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------'------------I---------------------------------------------- -------------- DATE----------------------------------- ------ <br /> Alterations and/or recommendations:---'-------=----- -------------------------------------------------------------------------- <br /> -------------- ----- -- ------------------------------ <br /> ----------------------------------------------------------------------- -------- --:--------------------- ---------------------------- -- --------------------------------------------------------------------------------- <br /> _ry <br /> -------------------------------------------------------- --------•-------------- - ----------------------------------------------------------------------------------------------------------------------------•- <br /> ---------------------------------------------" - <br /> --------------------------------------------- ------------ ----------------- ------------------------------------------------ <br /> ------------- <br /> � 4 <br /> � <br /> r� / .?.<3_ <br /> FINAL INSPECTION BY: ------ - -�:----- ------------------------------ Date_ --- - ------------------------------------ <br /> --------'--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 4 <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street - - <br /> Stockton, California Lodi, California Manteca, California Tracy, Californiaf <br /> 1=S-9-2M 8-51 Revised W-2100 :c °' <br />