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APPLICATION FOR SANITATION PERMIT Permit No. <br /> X (Complete in Duplicate) <br /> Date Issued <br /> !3 <br /> YAppliTafion is hereby made to the Son Joaquin Local Health District fora permit to c2ntrucf and install the work herein described. <br /> 'sapplication is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND �LOCATION--------------- <br /> ;Av /V <br /> Z ------- ----------------------------------------------------------------------------------- <br /> Owner's Name-------------P-----------------lfb! --------- - --- <br /> -- ---------------------------------------- Phone---------------------- ------------ <br /> Address---------_-_----------- C'j�?A 3 <br /> _%: <br /> ------------------------------------------------------------------------------- <br /> Contractor's Name-----1---------I-------------------I------------------------------------------------------------- --------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Z-*Apartment House F <br /> I Commercial El Trailer Court E] Motel El Other F1 <br /> Number of living units: Number of bedrooms Number of baths -1--- Lot size ----.1i_ _`1r/45__47 1 <br /> ------------------------------------ <br /> Wafer-'Supply: Public system Comm-un"ity system [] Private E] Depth to Water Table ------- ff. <br /> Character of soil to a depth of 3 fee+: Sand [3 Gravel E] Sandy Loam El Clay Loa-m 0 Clay E] Adobe 0 HardpanE] <br /> Previous Application Made: Yes [] N6'0 New Construction: Yes go No F-1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_-__ _44 -ofDistanceLfromjgundafion--,/,O-" lvlaterial------*4 <br /> No. of compartments--------__ -—------Size__rx__,K._X_S"Liquid de__pt__h_­__,IKII--------------Capacity----9-' 47-0 <br /> disposal Field: Dist <br /> tance from nearest well-_'t---- -Mstance from foundation- to nearest lot line__ _ <br /> .Nu,mber of:lines__---__---_-,----------------Length of each line--------A!54 .......... Width of french------ 41 JtZ <br /> Typee of filter material---- length_--.--_--_- ------------ <br /> p A04*_Depth of filter material-_/e----------Total - ---------------------------- LU <br /> Seepage Pit: -'Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-__-____--_-____ <br /> ❑ <br /> ine-_- ----------- <br /> El NLiFnb;r of.pits----------------------Lining material----------------------.Size:--------Size: Diameter------------------I_ Depth--------------------------------- <br /> Cesspool; <br /> epth------------ -------------------- <br /> Cesspool: I ? (n <br /> Distance from nearest well-----------------Distance from foundation-__.-___---_---.__ Lining materia}____------._--_-____-._.___._.__._. <br /> ------------ <br /> El t Siz6, Diameter--.---------------------------------- Depth----------------------------------------------------Liquid Liquid Capacity--------------------- <br /> 0 f ------gals. <br /> Privy, Xstance,from nearest well_________________________________________.______Distance L ----------------------------Distance from nearest building-------------------------------------- --- <br /> El Distance-to nearest lot line <br /> ---------------------- -- <br /> Remodeling and/or repairing (describe)--------------------------------___.._---__----._-_ <br /> -------•--------------------------- <br /> -------------------------•--------- <br /> describe):----------------------------------------------------- ---------------------------------------------------------------------- I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------- I-----------------------*----------------------------------------------------------------------*------------------------------------------------I--------------I--------------------------------- --------------I--------------------------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> I hereby certify that 1:,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� ------ ---------- ----------------------------------------.{Owner and/or Contractor) <br /> By-_---------------_-..---------------------------------------------------------------------------------------------------------------(Title)------------------------------------- --------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed on reverie side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --;­ ------------------------------------------------ DATE <br /> REVIEWED BY-------------------- ------ <br /> ------------------------------------------------------ DATE <br /> BUILDING PERMIT ISSUED------------- ------------------------------------------------ --------------------------------------- DATE---------------- <br /> - - <br /> ARerations and/or recommendations:------------------------------ ------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------I------------------------------------------- ----------------------------------------­---------------------------------------- ------------------------------- <br /> ------------------------------------- ---------------------- -------------------------------------------------------------------------------------------------------------- --------------------------------------------- <br /> ------------------------------------------------------------ ----------- <br /> ---------------*-------------------- ---------------------------------------------------- ----------------------------------------------------------- <br /> ----------­-------------------- ------------------------- ---------------- -------------------------------------------------------------------------------- ----------------------------------------------------------------- <br /> FINAL INSPECTION BY----------- ------ -------------- Date.-... .. <br /> ------ ------ --- ----- ----------------------------------------- <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 />