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f <br /> APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) <br /> i <br /> Date Issueda14 <br /> This <br /> is hereby made to fhe San Joaquin Local Health District fora permit ? / <br /> his a plication is made.in com fiance. t County Ordinance No. 549. p t to construct and install th©work herein described. <br /> JOB ADDRESS A ' CATION--_6 K1_aSA1j-,9N_ - ----- <br /> II '' <br /> Owner's Name ¢ � Q_ `1' Q <br /> p -------- ---------------------------------- -- Ph <br /> -------------- f p QQ------- _1� 1^�--------7�t /�G Phone ------ <br /> Address.. .� <br /> Contractor's Name------- ---------------- <br /> oV1 7_- <br /> ' Installation will serve: Residence ❑ Apartment House E] Commercial Phone--- <br /> Installation <br /> ' ❑ Trailer Court � Motel ❑ Other ❑ <br /> Number of living units:j-V4-- Number of bedrooms -------- Number of baths -------- Lot size <br /> Water Supply: Public system ❑ Community system -114 <br /> ' <br /> Y st <br /> Y ❑ Private0 Depth to Water Table�O_-- ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam E] Clay Loam E] Yoe ❑ Hardpan <br /> Cla Adobe p ❑..r <br /> Previous Application Made: Yes ❑ No New Construction: Yes ;q No ❑ -� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well" Qp______Distance from foundation- 10 <br /> ----------.I,J a to r;al 1--- <br /> No. of compartmems_ L�( �P ------Size �`� i -)tj ------- ---------- ' <br /> Liquid depth �'�------------Ca acit _,fw <br /> Disposal Field: Distance from nearest well-/e-0-`---.Distance from foundation-- p Y <br /> i <br /> . Number of lines__-!_X�-C��----------Length of each line__-�-- Q------"--Distance to nearest lot I�e- Q•�_____- ,� <br /> � LtC! Width of french-24-1-1 <br /> . <br /> Type of filter material_/1yA'--lfaG/�(,__Depth of filter materia l------/—"- ""-Total length_--Z-0,Q-0.0 _ <br /> Seepage Pit: Distance to nearest well_--_-_-__ <br /> Distance from foundation_________________-.Distance to nearest lot line--------------- <br /> Cesspool: <br /> Number of pits----------------------Lining material------------------------Size: Diameter----------------------- <br /> -Depth------------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------.----------Lining material._-___--".__ _______- <br /> ❑ Size: Diameter---------------------------------------Depth----------------------- ---- <br /> Liquid Capacity-------=--------------------gall <br /> Privy: Distance from nearest well------- <br /> -Distance from nearest building--------------------------------------- <br /> - <br /> ---------------------- - <br /> ❑ Distance to nearest lot line-------------------------- -- ------------- ' <br /> ~ ----------------- <br /> ------d -------------------- --------- <br /> ` Remodeling and/or repairi'g (de ribe):"_--. �ql���/g -r - -- <br /> � �. 6�_.- <br /> -Plv1�----- ---- r Vi ------------------------ <br /> -v'•-------------------•---------------------------------------- -------------------------------------------------- --------•---------------------------- <br /> -------------- to <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, a laws, and rules anW r..egulations of the San Joaquin Local Health District. <br /> (Signed]_ ,. <br /> --�--�---•----"P,/19 _R-1-6 --- AC-.c�S y �-----�-111 -�--- ------- ------- <br /> -(Owner nd or Contractor] <br /> BY:-- 1 _ ` <br /> U------------------------- -----(Title_- / <br />' ---- <br /> (Plot plan, showin size of lot, location of system in r lation to wells, buildings, etc., can be place on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> VIEWED BY <br /> ---------------------------------:f------------------------------_--------._ DATE_-�-------------------------------------------------- ' <br /> ------------------------------------------------------------------- DATE-------R� <br /> BUILDING PERMIT ISSUED------ <br /> y `(',f <br /> ----------"----------------------"'------- <br /> -- - <br /> ---------------- ---------------------------- DATE 11((�' <br /> Alterations and/or recommendations:-__"_-------------- <br /> --- ------- ---- <br /> - --------------------------------------••---------------------------------------•-----------• <br /> ----------------------------------------- <br /> ------------ <br /> FINAL INSPECTION BY:--------------------------------------------- <br /> =------------------ Date---------- --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street. <br /> 132 Sycamore Street 814 North "C" Street <br /> Manteca,Stockton, California Lodi, California i <br /> eea, California Tracy, California <br /> ES-9-2M $-51 Revised W-2100 <br />