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APPLICATION FOR SANITATION PERMIT Permit No. = .p' <br /> (Complete in Duplicate) Date Issued <br /> AV i 0 <br /> Application 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. r <br /> JOBADDRESS AND LOCATION------- ----------------- ------------------------ -------------------------------------•-------------------------------F- <br /> Owner's'Name---------- -r. - :r' --------- � ---------------------- ------ Phone----- <br /> LAddress-------------------------------------0-- <br /> - <br />` Contractor's Name---------•--------------- - --------------------------- -------------------------- ------------------------=-- Phone-------------------------•------- <br /> 'I <br /> I Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ _ Number of bedrooms _ �- 7 --------------i" <br /> . __,_ Number of baths __ ____ Lot size�_________�__�X_ _.1___________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft., ,I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan <br />'y Previous Application Made: Yes ❑ NoK New Construction: Ye�W No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ��#�/ <br /> Septic Tank: Distance from nearest well___��•-------Distance from foundation----/0..........Mate iaL GCJ tr _ 1� <br /> Liquid depth________ __Q_f_{____Capacity____��4___`_ <br /> No. of compartments---------—----------Size_-.... _ �C f <br /> Heid: Distance from nearest weil___ v_____.Distance from foundation ___---Q__.____Distance to nearest lot line_ <br /> Drs os Ir <br /> Number of ---Length of each -------.Width of tren h______Z_��_r_ __ y:_ <br /> Type of filter material-___A-v ,---_Depth of filter material________ _________-Total length._ :-____.______�_D ` <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance'to nearest lot line------------------ <br /> F ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth-------------------------- ! <br /> Ces❑spool: Distance nearest well ----------== - # ce from foundation <br /> Fning material------------------------------------- <br /> Size: <br /> -- -------------------- <br /> SizeDiameter -- =- Dep}hLiquid Capat ____________________________gals.,. 1 <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------- <br /> 0 <br /> _______________-__._____________ -❑ Distance to nearest lot lin _ Y ------------------------------------------•----••------•------------------------------------------------•-----: <br /> ------­---------------- <br /> Remodelin and/or repairing (describe):_*-________________ ' <br /> -� :=--�--- , <br /> --------------------------------- ----------------•--•--•-- --•---------------------- _ <br /> ---- ` <br /> hereby certify that I have prepared this application and that theswork will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and deg lotions of A San4Jjoquin Local Health District.Si Held( 9 --------------------•---------------{Owner and/or Contractor) <br /> By: ---- - - - --( )--------•------------------ <br /> ' Title � <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). l <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------•.----,--.- ----------- DATE-------------- <br /> ------------ <br /> DATE <br /> ------------- - <br /> K _ i ------------ C <br /> ---------- --- - <br /> REVIEWED BY "`""!___. DATE----------------------- <br /> BUILD]NG PERMIT ISSUE(? - a = r �' = :' ```` 1 tom, "ti.jlle ;.�:�;�W4, <br /> A erations and/orrecommendations:------, �' t ...` '----- •------•------------------- ------- <br /> I -t-" ~`'$ --------- `b"s `n`'_, `j?` �r ,�.�----------------------- ----------- --------------- <br /> ---------------•-------------------------------•------------------------------------•--------------------------------•-------------------------------------------------------------------- • iN <br /> FINAL INSPECTION BY:__ __;�_. ______-------_ <br /> ------------ Date-----% _ --------------•-•----------------•I' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT II <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 /> E5--9-2M B-51 Revised W-2100 <br />