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APPLICATION.. FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date IssuedCv7_/_ ,x_v <br /> A lica�ion is h6reb made to the San Joaquin Local Health4District for a permit to construct and install the work herein described. <br /> Thisap lication is made in compliance with County Ordinance <br /> . ' - No. 54d9. �/J. <br /> /-=-c•�- <br /> — ------------ --_ � t/ ltr5- <br /> —*JOB ADDRESS ;D LOCATION______- .- = - - � Pho�e..--------.Owner -------- L <br /> k <br /> Address ___ _ - :' 4 ,- .. ------------------- ------- ------------------------------------------------------------ <br /> ---- <br /> Contractor's Name:'-�?'f- -! ' f" a ( 'x»`'// -.--." -• - Phone-----_------------------ <br /> Installation will serve: Residence ❑ Apa-rtment House ❑ C61/lercial ❑ Trailer Court �, Motel El Other { <br /> Number of living units:`___.-_-_-`Number of bedrooms Number of baths __ _____ Lot size ___ ----------------- fi <br /> Water Supply: Public system ❑ Community system ❑ Private, ] Depth to Water Table ._- - ft- <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 X New Construction: Yes ANo ❑ <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----)0 ''Distance fro foundation__--___y_'__.__._.Materi I_____________ ___ <br /> No. of compartments <br /> ------ Size._i�_X__W .S _Liquid depth_:------__ ..____.___Capacity....Is- <br /> ---------- <br /> Disposal-Field: Distance from nearest well___! 0_}Distance from foundation----�O------Distance to nearest lot line-_ ---__ <br /> Number of lines-------------!---------__---------Length of each line_______AC?-------._.Width of french----- __ __ <br /> Type of filter material_.__- epth of filter materiaL_____1-2--_---_.__Total length______Lq_0___________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation__-.________....___.Distance to nearest lot line______._________ l <br /> ❑ Number of pits----------------------Lining material-----------.-----------Size: Diameter-----------------..___.Depth---------------.--._--..--------- <br /> � r <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-..-.--------------- Lining material-------------------------------------- <br /> Size: Diameter--------------------- - ------Depth-----------------------------------------------------Liquid Capacity gals. <br /> -.-------- <br /> Privy: Distance from nearest well------------------.-------------------------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line------- ---------- ------------------------•-------------------------•-------------------------------------------•---------------------- , <br /> i <br /> Remodelingand/or repairing (describe)------------------------------------------------------------------------• ---_.-.-..-...--------------------------------------------------------- ...... a <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 the San Joaquin Local Health District. <br /> (Signed) �. =r r'- f ----- ------ ----- ---- - J (Owner and/or Contractors I <br /> By:............ . ...... ° qtr -------------- -----------------------------------------{Title)------17u--L- ' [�--- ------------------ <br /> (Plot plan, showing size of lot, [ovation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ZZBY--------------------------------------- <br /> ------- ---------------- DATE----------- ------- ---------- <br /> REVIEWEDBY------------------------------------------- -------------- DATE--------- " ----�� <br /> BUILDINGPERMIT ISSUED-----------------------------------------------------------•----------------------------------------. DATE.---------- ------------------------------------------------ u <br /> Alterationsand/or recommendations------------------------------------------------- -•------- ---------------•-•--------------------------------------------------- ------------•-•- <br /> c <br /> tcl1...-- h saw- ! 'n-----emt------- -1 l�.'�_I------------- - Z - ---- <br /> S!_ �s-�'d u¢c a; r.. = <br /> --�4�fs.l�.�--�----�-}-��-- -��-4`-----'-�1/:�i�C�C:�--'���'-�---.�-�'—$'--�--•--�- �-�4 ..t,.G-44---°�-�_.se�.aJ-----4�Sh.�'_r�=----�•-•--'�-g-•-•--•---....--- <br /> ---- ----------------•--------------------------------------------------------------------------------------------------•-------------------•----------------------------------------------------------------•-- <br /> ------------------------------------------------------------------------ ----•------------------------------- •-------------•--------------------•--------------------.-.-.-:------------------------------------------------ <br /> FINAL INSPECTION BY:.... V--_ .'7- _L- 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 /> E5-9-2M ;,Revised W-2100 <br />