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may'ois <br /> '� APPLICATION FOR SANITATION PERMIT Permit N ---... <br /> t <br /> li <br /> D <br /> i <br /> l <br /> (Compete n Duplicate) <br /> a. 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 compliancewith County Ordinance <br /> �No. 549. <br /> JOB ADDRESS AND LOCATIONX-01.2s a..� � �-----�``"" �'az'°J------------------- <br /> Owner's Name----------------------------------------------- 11 .C_f -L-!J----- -}-'J 'F' ---------------------- Phone------ ------ <br /> Address---------------------------------------------------------- <x.2------` pPza-------------- ------------- <br /> Contractor's Name: ------------------------------------------------------ <br /> -------------------------------;---- ---------------- Phone--------- !__0, ------ <br /> --- <br /> Installation will serve: Residence IM Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1-___ Number of bedrooms-___2*" of baths __- --- Lot size _______ - p_'->e_--A2_4--- -------------- <br /> Water Supply: Public system fK Community system El Private F1Depth to Water Table __Qft. <br /> Character of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (l Hardpan ❑ A <br /> Previous Application Made: Yes ❑ No$?_ New Construction: Yes 5jL_ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> �® r <br /> Septic Tank: Distance from nearest well--- )_-Distance from foundation__ ._,'1_ __.-__Material________________ __ <br /> No, of compartments----_- --- Size--- 1. - -_--------- Liquid depth----&=a --Capacity-- ?---------- <br /> �a�r �!r-------Distance to nearest lot line____ --. <br /> Distance from undation__ __ <br /> Disposal Field: Distance from nearest we-L,------------- Le 9th of each line------cP-�--------------Width of trench_...t9---4�-** <br /> Number o� lines-- --`------�--------------- ---Len <br /> Type of filter material-. of filter material-----l_�."__ -_..Total length___._.. __P_.'____.__-°_____________ <br /> Seepage Pit: J Distance to nearest well___./_ `_____Distances from foundation_-_----.Distance to nearest lot line______ <br /> material -C&k.1 ----Size: Diameter_____ 'i_..____.Deptn_...�_C-."---------------- <br /> Number of pits.-____f____ <br /> ---------Lining <br /> Cesspool:. Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------- --- <br /> . <br /> ElSize: Diameter--------------------------------- ---Depth--------------------- -----------------------------Uquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well---------------_-------------------------------__Distance from nearest building_____..._._._______________.._--_-_..._. <br /> ❑ Distance to nearest lot lire------------------------------------------------------------------------ ------------------------------------•--------------------- - <br /> Remodeling and/or repairing (describe):-------------------------------- ----------------•-------------------------- -------------------- <br /> ------------- <br /> --------------------------- <br /> 1 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;a rules and reguhd`t'ons of the San Joaquin Local Health District. <br /> ---------------------------------- ------- Contractor] <br /> gY� 'f�''`� J. <br /> {Title) � � <br /> (Plot plan, showing size of lot, location of syste in relatio t ells', buildin s, etc., can be pl ted on reverse side). <br /> FOR ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- --- ------------------------ ----------------------------------- ------------------------ DATE_�------------------------------------------ <br /> -- - ------------------------------------ <br /> REVIEWED BY. - ---- DATE <br /> BUILDING .PERMIT ISSUED------------------------------------------------------------ DATE---------- <br /> �- ---------------- ----------- - <br /> Alterationsand/or recommendations---------------------------------------------------------------------------- -----------------------•----------------------------------•------- ----------•---------------------------- <br /> --------------------------------------------------•---------------------------------------------------------------------•------- <br /> ----------------------------------------------------- <br /> ---------------------------­­-------------------------------------------- -------- --------------- ------------------------I-------- <br /> Od <br /> FINAL INSPECTION BY:--------- 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 /> ES-9-2M 10-52 Revised W-2100 <br />