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\�\ APPLICATION FOR SANITATION PERMIT Permit No. ..41./P.. .._.. <br /> (Complete in Duplicate)�.� yZ Date Issued .._..!__�/S�__.. <br /> Applica+ion 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 compliance with County Ordinance No. 549. <br /> l•� f ------- U� <br /> JOB ADDRESS A OC ON.... . - --Q --- --------------^--------------------------------------------------------- <br /> Owner's Nam/e = '---------------------------- ---- Phone.-----------------------•---------- <br /> Address......4. ... • --- ---------------------------------- ---- ------- ---•-- ----------------------------------------.------------•------•-----!----------- <br /> Contractor's Name... ....... ....... c -__-.---. Phone/4�7�b [ L <br /> Installation will serve: Residence partment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .1----- Number of bedrooms ----/. Number of baths _/.... Lot size _Lr0._.,y\-----jZI-P-___-__--.--__.- <br /> Water Supply: Public system ommunity system ❑ Private [4- 0-e-epth to Water Table SX�vft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ar an ❑ <br /> Previous Application Made: Yes ❑ No 24­1ew Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tar*:-- . Distance from nearest well------------------Distance from foundation....................Material______-.----._-___----.---___----_-.--_--.-_----. <br /> No. of compartments--------------------------Size----------------------------•---Liquid depth--------------------------Capacity----------------------- <br /> isposa�l Field: Distance from nearest Ql__-Distance from found on... __CL5.------Distance to ne est t line..2O-( <br /> L�/ Number of lines__..._.../_.-.J_ _ _ Len Length of each line_._. �.._,.......Width of trench--- .( ------------------------ <br /> Type <br /> ---------------------- <br /> Type of filter material__---- - -- ---_ epth of filter material- .. ............Total length....... ------------------------- <br /> Seepage Pit: Distance to nearest well_/_Q_!5�-------D' ance from o tion.ZQ...... Distance to nearest lot <br /> Number of pits----(/--------------Lining ma e: Diameter__--�1? ._--------Depth---Z_Q___________________ <br /> Cesspool: Distance from nearest well-----------------Distance rom oundation--------------------Lining material._..-----_--_------------___-_---_--_. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------- -----------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well -.--__..--------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line----------------------------- ---------------------------•----------•------------•------------------•------------------------------- ------ <br /> Remodelingand/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, la , and r and re Mations of a San Joaquin Local ealth District. <br /> (Si ned �'� <br /> ig )--••- -•-•- --•-- _ for <br /> By:.--- ? --- ------------------------------------------------(Title)---- . -•--••---•-----------•------ <br /> (Plot plan, showing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- -- -•----- ------------------------------------------- DATE------- <..----- ------------------------------------ <br /> REViEWEDBY---------------------------------- ----- --------- ------ -------------•------------------------------------------------ DATE---------- ----�-•--••--...-------•------•-----------. <br /> BUILDING PERMIT ISSUED - - DATE -------- ---�.--------------------- <br /> Alterations and/or recommendations--------------------------- ----- - -- ------------------------------------------------------------------------•---. --- <br /> ---------------------- <br /> ------------------------ <br /> -------- <br /> ' �,,� -- --1s... . -------------------------------------------------- --------------------------------- <br /> FINAL INSPECTION ---- Date------� _ /? <br /> -,S-6 6 � <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 /> i <br /> ES-9-2M _`145446 ATWOOO 12-54 <br />