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1 <br /> -53 APPLICATION FOR SANITATION PERMIT Permit No. s�.,7 <br /> (Complete in Duplicate) <br /> Date Issued ._ ........ <br /> Application is herebya��to the San Joaquin Local Health District for a pe t o co truct a to th ek rind cribed. <br /> Thi application i mad 'n o w' <br /> ss e i compliance it County Ordinance No. 549. <br /> JOB ADDRESSSD LOBATION- ._•Ck/: �:_ _ _.- __-!G----- <br /> ---- <br /> _- <br /> r .,. <br /> Owner's Name- �'� -._ Phone Z__ <br /> -a -- --- <br /> --- <br /> Address----____ - .. <br /> 2 _» <br /> -------- <br /> 17C <br /> Contractor's Name ,f-Z=l y----------------- Phone. <br /> Installation will serve: Residence ['/Apartment House ❑ Commercial ❑ Trailer Court ❑ �M}otel ❑ Other E] j <br /> Number of living units: __1--- Number of bedrooms __! !_. Number o baths -__�__: Lot size ___1 _ _ X__: _�_Lf _____.:.___" ♦-;.- <br /> Water Supply: Public system 10 Community system ❑ Private Depth to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Lo;"No <br /> Clay Loam ❑ Clay ❑ Adobe Hardpan Q <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if publiC sewr is available within 200 feet.)#` <br /> Septic,,Tank: Distance from nearest wel �_ .,_;_,_Rsiance 12 1 from/foun�(a ion__/_O_ "_...ateri Iz_ ''____ _"__7� :__��___No. of com artments__- ..__.__SIz _ .w� .___Li uid de tdi ________ __ _ _________Capacitypq P ----_. <br /> Dispos Field: Distance from nearest w Ik?a _� C"'Distance from ------Liquid <br /> _.. istance to nearest lot ine•- <br /> . „ --- --- <br /> Number of lines__________ _------"�__--___-_ -Length of each line--------- �__-Width of french.------._�.�_---------_ <br /> Type of filter materi _!j ",f epth of filter material__ _-"-_1_�-" __Total length______________�.�_jo_______.._- <br /> �~�' _____Dista ce\rom foundation _______________.Distance to nearest lot line__-____________ <br /> Seepage Pit: Distance to`nearest well__.._.-___•_ <br /> ❑ Number of pits------------•---------Lining mater' I•----=-----------------Size: Diameter-----------------------Depth-------------------------- <br /> Cesspool: Distance from nearest well_______ -----r.Dstn from foundation_______-________.Lining material_________________-_________-____ <br /> El Size: Diameter------------------ -------------------Dept <br /> ---•- ---------------------------------------------Liquid Capacity-------------------_---•---ga <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building---------------------------------------- <br /> ElDistance to nearest lot line ----•--------------=--------------•----- •--------•---------"----•---------------------•-------------------- <br /> R modplinQJ nd/or repairin ibe): _j <br /> y --------••---------------••--•-••-•------•---•--•• -------- <br /> . . -- ---- - - = ==�'....................... <br /> -----------------------------------------•------------------------------------------------------------ •---------------------- -- <br /> --------------------------------••---------------------------------------------------------------- ----•4-------------------------------------------•---------------- <br /> I hereby certify that I have prepared this application and.chat the work will be done in accordance with San Joaquin Coun <br /> ordinances, St�o e�laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) = - �_ I -------------•------------ ------------------------(Owner and/or Contractor) <br /> By:.........................................................................................t-----------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to Yells, buildings, etc., can be placed on reverse side). <br /> FOR DEPART ENT USE ONLY <br /> APPLICATION ACCEPTED BY.—- ------ --------------------------------- `" ------------------------------------ DATE;;"'----------------------------------------------------- <br /> REVIEWED <br /> ----------------- - ------------------ --------- <br /> REVIEWEDBY--------_--------------------- ------------ ---------------------------------------._ DATE----:;�---+-------- ---------------------------_---------- <br /> BUILDING PERMIT ISSUED........... ------------------------------------------------ -----------------------•--------------- DATE------ .&------ •••-•---•------------------------------- <br /> Alterations and/or recommendations:---- -""------"----------------------------- :--------•-------"---------------------------------------------------------"--•--------------------------. ._.. <br /> ..............-------------------------------------•-----•--•---------.... ---•------------------------------------------------�Epf� � - __••-•- ---------.•--.. --- ------------- ---- <br /> ----•------•-•-----•--•---- - ------------------------------ ------------------------------7. -------------------------------------------------- --- ................. <br /> -•••--•----•-- ----------------- <br /> FINAL <br /> -- -----FINAL INSPECTION 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 0-52 Revised W-2100 <br />