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APPLICATION FOR SANITATION PERMIT Permit No. <br /> 42-1 (Complete in Duplicate) <br /> te Issued 112 <br /> scANNED .... .......... <br /> ApPlica+ion is�!reby 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 n compliance with County Ordinance No. 549. <br /> JOB ADDRESS AZNDL90 Al:�� -7 <br /> -- ----- ----- ------ -- -------- - <br /> ---------- ------------------------------------ <br /> Owner's Name..- <br /> - --- --- ------- - ------------ ---- <br /> Address------`-......... -------------- Phone. <br /> Contractor's Name <br /> --- --- ---------­------------------------------------------------------------------ <br /> d,!—------------- ...... ---------------........ <br /> ----- -- ----------------------------- ----- Phone_... <br /> Residence 21- Apartment House 0 Commercial El Trailer Court 0 <br /> Installation will serve: <br /> Number of living units: Motel C1 Other C] <br /> --- Number of bedrooms _-.'>—Number of baths/.._._ Lot size ----J6.0 _x <br /> Water SUPPIY: Public system Q ---Z.4�_ ------- --------- <br /> Character of soil to a depth of 3 feet: t,5;vt <br /> Community system El Private El Depth to Water Table ft. <br /> Previous Application Made: Yes 0 No 19- New Construction: Yes No 0 <br /> Sand El Gravel D Sandy Loam E] Clay Loam E] Clay ❑ Adobe E�L, Hardpan [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: JQ_ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_4.1�� 4)__t...Distance from foundation----/0...e..-.Material----- <br /> No. of compartments_..J�L__...---_--.-Size.__ ------- <br /> Z,_j�_!V4- Liq u d dep <br /> Disposal Field: i --------Capacity--- <br /> Distance from nearest well e --------- <br /> Number of lines_....___.. ---Distance from founc1afion_,/_,g_55_,------Distance to nearest lot <br /> Length of each line------- ----------Width of french-- <br /> Type of filter material.../_. ON trench_._ ------------------ <br /> -5-P—Depth of filter material..-_42. ....Total length........... - I <br /> .t5,e- <br /> Seepage Pit: Distance to nearest well_,/_iq_P _ Distance from foundation_...._-;:.?A- ---------------------- <br /> 01 Number of pits--- _..Distance to nearest lot line-------Z, <br /> I--------------Lining material__4W.d- ------45 a: Diameter----- Depth.- _,f2. *Ef7 <br /> z -- -------- <br /> Cesspool: Distance from nearest well------------- --Distance from foundation.__..______ Lining material--. _. <br /> F1 Size: Diameter_ ...Depth------- --------- ------ ----- -_ ------------------------ <br /> Privy: Distance from nearest well-_ -Liquid Capacity_._-- --------------- -----gals. <br /> ❑ Distance to nearest lot line.__._.__..._.---.-_-_---__.--_-_-.__---_----- ------------- --Distance from nearest building-------------------------------- ------- <br /> ----_- ------------------------------ ------------------ -----I------ ------------ <br /> ---------- <br /> ------------------- ---------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe): <br /> .......................--_-------------------------------------------------------- --------------------_-----------I------------------------------------------------_------------------------------------------- <br /> -------------------------_-------------I----------------- -------- ---_--_---------------- ------------------------- ------------_------------------------------------------------------ __- ------ --- <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, Stat _Wp and rules and regulations of the San Joaquin Local Health District. <br /> (Signed- --------- - ---------- ........... (9)wner and/or Contractor) <br /> --- - --- ------------(Title)........ <br /> of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. --------------- ------- <br /> REVIEWED BY----------------- <br /> -- ----- -- ----- -- - ----- - - ------- -- ---------- --------------- DATE----ItA------------ <br /> BUILDING PERMIT ISSUED.------------------.- . ------------------- - ---------------------------------------------- DATE.---- ----- ------------- -...-- ---------------- <br /> Alterations <br /> ----- ----------- --- - -- --- -------------- <br /> Alterations and/or recommendations:__ - - ------------- -- --------- - --------------- --- - --------- - - ---- ------------- <br /> -- ... .. . . . ............ ­- <br /> ..... <br /> - <br /> -------------- - --- ----------__­..... ---- .j--- --- ... ........ <br /> .............. ..... . ........ -------------- ------- -- ... ....... ...... .... <br /> FINAL INSPECTION BY:..... <br /> Date........ --- ---- - ------ -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfreo+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E9 9 145 .pTWoqu <br />