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APPLICATION FOR SANITATION PERMIT Permit No. ... . ...3 Z <br /> 4 ,) <br /> (Complete in Duplicate) Date Issued r/Al/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 ounty Ordinance No. 549. n <br /> JOB ADDRESS A LOCATIO - ; � p .. - . <br /> nn <br /> Owner's Name.............••. --'--------••-•---........................ ---------------------- <br /> -. Ph e.. .Gl.. _"P <br /> t <br /> Contractor's Name-Vt.��' .-n -•-- ...--- == ------ -• 1" '""..�`at� Phone - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel [-] Other ❑ <br /> Number.of living units: ._____ umber of bedrooms -%3-. Number of baths ..l-.. Lot size ✓!__!._ ���--"' <br /> Water Supply: Public system [�ommunity system El Private Table Private ❑ Depth to a <br /> Character of soil to a depth of 3 fee+: Sand 0 Gravel ❑ Sandy Loam Clay Loam El Clay C] Adobe 2/Hardpan ❑ <br /> Previous Application Made: Yes F1 No V New 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 /> Se tic ank: Distance from nearest wel600���an from at' f_�� Mater' I ..P /� i_t*---[7 No. of compartments N - � uid���lepih Capacity <br /> Dispos Field: Distance from nearest wel#�_Q-----___- istance from foundation-- ---------------Distance to nearest lot lin - � <br /> it.... <br /> Number of lines---------- ----- --------- -Length of each line---..-.---__--0.elt Width of trench-----.-_.�-- <br /> Type of filter materi *'--._ epth of filter material Total length._.. ,Q r . <br /> See Pit: Distance to nearest w II-1.0.0-----------Distan f ,fo dation 4_``""ista cyto nearest lot 'n <br /> Number of pits-__..__-_------_._-Lining material______ _______ ___ ize: Diameter._________.__Dept h--_-.__ __,....._._.--. <br /> Cesspool: Distance from nearest well---------------- Distance from foundation--------------------Lining material.__----.----_----------..------_--.-. <br /> ❑ Size: Diameter-------------------------------------Depth---_------------------------ ----------------------Liquid Capacity............................ <br /> Privy: Distance from nearest well-----------------------------------------------=-Distance from nearest building----------__--------------------..------ <br /> ❑ Distance to nearest lot line----------------------------- -------------------------------•---------•------------------------•--------------------•----------•--•-------- <br /> R mod mg d or epairin tribe :___ _--__ - <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) --------------------------------------- -------------------- -----------------------------------------------------------------------(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 reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-- ------------- -------------------------- ---------------------------------------------. DATE�'�"'- .....................................--------- <br /> REVIEWED BY. ---------------------------------- DATE v <br /> . ----•--'----------------•-------•---'------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------ <br /> - ---- --- - <br /> Alterations and/or recommendations-- --- ------------------------ -------------------------------------------- -------------------------'-•-- .....---. --------------•-----••--••---..... <br /> L --- --•--------------•-----•--•--•--•--•-•-•••------... -----•--•- <br /> --------•------------ ------- - --- --- ------------ ------- <br /> - - <br /> FINALINSPECTION BY:---- -----------_--------------- 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 /> ES-9-2M 145446 ATWDOD 12-54 <br />