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.;.. - _ <br />' t APPLICATION FOR SANITATION PERMIT Permit No. .... 3.....7--- <br /> /�.� lI (Complete in Duplicate) z� 7 <br /> "1 'k v _ Date Issued <br /> Applica+ion is hereby made to the San oaquin Local Health District for a permit to constru t and i stall the ork herein described. <br /> This application is mad n complia c County Ordinance No. 549.' <br /> JOB A �SS AN <br /> ---ISA ' '--------------- 1,�C-------------------------------------------- <br /> Owner's Name ---- - -----------A --------------------------•-:---------- Phone_,-----------------_-- = <br /> SSc� � 1 <br /> In talla +. <br /> Contra'ctor s Name - - Z-e ---------- -•--- Phone-- <br /> Installation <br /> hone- <br /> .._ ❑ <br /> tion�irill serve: Residence `,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ -Other <br /> Number of living units:.-____ Number of bedrooms <br /> Number of baths, - Lot size -__ -____-__ '- <br /> Water Supply: Public system ❑ Community.system ;._Private ❑ Depth to Water Table 6: ff- r <br /> Character of soil to a depth"of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[ Hardpan.❑ <br /> Previous Application Made: Yes ❑ No Z_ New Construction: Yes,V No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_w�P-__--Distance frofound tion__ _- <br /> _� -------- !!` <br /> Q No. of compartmen � <br /> ts_---- -.-- --Size--- _ 6?aLiquid depth---k -------- pacify <br /> Disposal Field: Distance from nearest well,_-_.7x _Distance from foundafian_/!�_r..__-Distance to nearest lot line---li------•, <br /> Number of lines---------- ...- _ Length of each line_-_____-- ._� _�-----Width of trench___-- :�__��-_-_---- <br /> .,.; 9 <br /> Type of filter materiaf_._.l __-__.A&pth of filter material___ _____Tofial length___.__ - <br /> -----­------------- <br /> Seepage <br /> ----••----------•--Seepage Pit: Dist-ance to nearest y---Distance fr m foundation___ /-_�� <br /> .__-_:,Distance to nearest lot line--- ..___ <br /> (}4— Number of pits----/------------Lining material_ a_ _._ Size: Diameter-------�-n_ -"_IDe p fh------ , <br /> --------- <br /> Cesspool: Distance from nearest well-----_-----------Distance from foundation-_- ------------- Lining material-----------------------------.________- yj <br /> [ " - Size: Diameter------------------- - ----- ----------Depth--- •---- - - ------Liquid Capacity gals. <br /> -Privy: Distance from nearest well ____________-----------------------------------Distance from nearest building------------------------------------------- <br /> ED <br /> Distance to nearest lot line_______._--------------------------------------------------- <br /> Remodeling and/or repairing' (describe)_-------------------------- <br /> ------------------•-----------------------•------------------------------------------------------------------------------- <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 �ws, d rules and regulations of the San Joaquin Local Health District. <br /> --- ---- - ---- -------- --- - ------- ----(O er and/or Contractor] <br /> (Signed) <br /> B - <br /> - - - - -- - - --------------._Title - <br /> ( � - ��- ----'tel----------------------- <br /> (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- -- DATE---_-- -•--- -- <br /> ---------------•------•-----------••-------------- <br /> ---------- - <br /> REVIEWED BY-----------------------------:--------------- ------------- ----- ---------------------- ----- DAT E-------._ ::_s,/. <br /> BUILDING <br /> PERMIT ISSUED-------------------------------------- •--------- ------ DATE---------- <br /> --- ----------------- -- <br /> Alterations and/or recommendations------------------- -- - -- ---------- •--- <br /> ------------------------- _-�----- ----------------­---------- -- <br /> --------------------------- --- -------• :--- <br /> •-••----------- -- <br /> FINAL INSPECTION BY:-------- -. <br /> �---�----------- ---•---------------- Date..... <br /> �-=�-=-`r--.r_���-�--�- --------------- --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT '`v ; <br /> 130 South American Street 300 West Oak Streef 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> y ES•�•9 145446 ATWdgo <br />