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APPLICATION FOR SANITATION PERMIT Permit No. <br /> 49,1 (Complete in Duplicate) £� <br /> Date Issued _y <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 Ordingnce No. 549. <br /> 3 <br /> JOB ADDRESS AND LOCATION----------------_q_S,1......_--- OlL----------------------------------------------------------------------------------------------------- <br /> Owner's Name--------------'---------------- --------5,;-117 f7N ' ------------------------------------ Plione..................................... <br /> Address----------------------------------------------------------------------------------•----- <br /> Contractor's Name-----------------------------------------------------QGt i'`, '------------------•------------------------------------------------ Phone-------•----•----_----•--_---- <br /> Installation will serve: Residence,d Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ________ Number of bedrooms :_ Number of baths ________ Lot size ______ -__ --1 ----------___________ <br /> Water Supply: Public system Community system ❑ private ❑ Depth to Water Table ________ ft. <br /> - Characfer of soil to a depth of 3 feet: Sand ❑ r Gravel 0 Y Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado b Hardpan ❑ <br /> "Previous Application Made: Yes ❑ No New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFI ATIONS: <br /> �. (No septic tank or cesspool permitted if public sewer is available within 200,feet.) <br /> Septic Tank: Distance from nearest well----,M------ from foundation-----1_Q___ _.Materia{---------- - _-____._______- <br /> �( ,•No. of compartments_-___).___`___.____..__Size____szf_14-3____-.Liquid depth,______=_�1i�_______Capectty____-__���____ <br /> v4. `1 x �, <br /> Disposal Field: - Distance from nearest well-__-.PW-----Distance from foundation___- --------Distance to nearest lot line____S'f----- <br /> w ' Number of lines--------------_ Length of each line____ .Width of french----------� U <br /> Type of filter material_____ y______-_____Depth of filter material___---f O-_______Total length______1__ _�_ __________________ f <br /> Seepage Pit: Distance to nearest,'well-----,------------------Distance from "foundation---------------------Distance to nearest lot line-----------_---- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- <br /> - _Gesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material___.______-__._---_-___--___________. <br /> ❑" . Size: Diameter.---------------- -------- --------..Depth--------------------- -----------------------------Liquid Capacity---------------------------gals. <br /> 00 <br /> Priv Distance from nearest yell______._________ <br /> t ______.___________.Distance from nearest building " <br /> Y - g--- ------ ------------------------------ <br /> k°f. ❑ � 9 ,Distance to nearest lot line------------- y- ---------- ------------------------------------------------------ '" C <br /> Remodeling and/or repairing (describe):------- --__ --------------------------------• ___-- ro' <br /> T: '-I <br /> ----------------•--------•------------------------------....--- ---- <br /> t ------------•----------•-------•-------- <br /> ' . <br /> i <br /> ! hereby certify that I have prepared'+his applica+ion and that the work will be done in accordance with San Joaquin County <br /> r* ordinance , tate laws, and rules anjr�egdlations of fhe San Joaquin;Local Health District. <br /> 7. <br /> (Signed ``„ - - ___(Owner and/or Contractor) <br /> pian, <br /> -------------------(Ti+le)----------------------------------------------- <br /> -(Plof plan, showing size of lot, location of system in relation to wells,Fbuildings, efc., can be placed on reverse side). <br /> y <br /> FOR DEPARTMENT USE ONLY% , <br /> APPLICATION ACCEPTED BY----- ------------------------------------------------- DATE " <br /> T <br /> / ----------------------- r �5- <br /> REVIEWBY------ ----------------------------- ----------------------------------------------------- <br /> ED' -------------- DATE------------------ --------------- � <br /> BUILDING PERMIT ISSUED-------------------------------------------------i. -y - ----- DATE._ <br /> „ -• <br /> II, <br /> ' Alterations and/or recommendations:------- Y = ---------------------------------------- :. <br /> r j�i�R f j 1 ------------ C_---------�4 f------ ------- <br /> - <br /> - <br /> ---------- <br /> -------•-•'--------------------------------------------------------------------------------------------------------------------------- ---------- � <br /> ------------ ---s <br /> --- - - <br /> FINAL INSPECTION BY:---------- <br /> Date.- � r- s <br /> :4 !� <br /> N JOAQUIN LOCAL HEALTH DISTRI <br /> ( 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfh "C" Street <br /> Stockton, California Lodi, California Manteca, Califo�nie Q racy, California <br /> ES-9;_-2M ; Revised W-2100 _ <br />