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rmit No. <br /> APPLICATION FOR SANITATION PERMIT � � Pe .._i�_S _ 1 <br /> {Complete in Duplicate] 7 <br /> Date Issued •__ ___' <br /> 4T�plica-lion is hereby made tot a San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> s application is made in compliance with County Ordinance No. 549. <br /> i } <br /> JOB ADDRESS A CATI � <br /> .Owner's Name - -- rPhone. <br /> ---------------------------------------------- <br /> Address------------- +_ ------ <br /> C' c9 4 �i-m -rw <br /> ....._ .� : - C- ------Wi <br /> Contractor's Name----------•--Ae' t ` -- --------- -• ....... =r'•-�'----------------------------- ----------------------------------- Phone. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth % <br /> Number of living units: _____ Number of bedrooms _ Number of baths -------- Lot size ___ ?_ 2 _ _____ ---------I <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [�- "Iardpan ❑ <br /> -mow ..,-;---.--'- <br /> Previous Application Made: Yes ❑ No 5P-'New Construction: Yes o ❑ . I' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) <br /> Septic T k: Distance from nearest ell _Distante from foun`detion- - <br /> [ <br /> No. of compartment _ .t <br /> Size__ Li uid de th_ <br /> Disposal -Meld: Distance from nearegt well Q istance rom foundJ)gi�.I-q-- .._.._.Distance to nearest lot line,-,-,- <br /> f Q . <br /> Number of lines----- _, .-_ —�# Length of each line___,]``-„ �i1,Vidth otrench___ r -_ �1_.____ <br /> t ��••�� r s s.. <br /> Type of filter material__I_�)j_.J�I�� -_-Depth of filter material-_-.._/_____Total length <br /> Seepage,,Pit: Distance to neare t well_ _ __Distanc orn�f ndation_p�----.-----Distance to nearest-iot line____ --------- <br /> Number of pits.--- ..---------------Lining material- ___Size: Diameter__.-Tc ''r____Depth_:-.Z.. 0--__.-..-____. <br /> Cesspool: Distance from nearest well-.:-!°----------Distance from foundation_._:...............Lining material-- ----------------------------------- <br /> ❑ Size: Diameter-------------------------- --- -- ----Depth- ------------------------------- ------- ------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-____ _-__---______:________.__..__.___. <br /> t ❑ Distance 'to nearest lot line---------------------- <br /> Remodeling and/or repairing [describe)_---------_---------_____ _ __ '" �r <br />'rt <br /> ------------•-•------- - ----•-------------------------------•-----------------------•----------------------------------------------------• <br /> --------------------------------------------------------------- <br /> 1 � l t <br /> k I here ,yVr,,,yna prep red this ap ation an that the work will'be dane'in accordance with San Joaquin, County <br />;. ordinances, Sbs an regulations o the San oa uin LocalHealth District,t <br /> (Signed)--------- ---- -- ---------------'�� --------------------- -- --- ----- --- - -------------------------- _ -. Contractor) Il <br /> BY: ------(Title) 1 = 1� Q `'--` --------- <br /> --------------------------------------------------- --------------- -- -------- <br /> (Plot plan. showing size of lot, location of system in relati o wells, buildincisiletc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY x <br /> APPLICATION ACCEPTED BY DATE s'3--------------- <br /> REVIEWED BY DATE <br /> BUILDING PERMIT ISSUED--------------------------------------------- - ----------- ------------------------------------ DATE.----'i�_'�""_ <br /> Alterations and/or recommendations------------------------- <br /> ----- •------ ---- <br /> E r <br /> --------------'--------------------- ---------­------------­-- ------ --------------------------------- --------------------------------------------------------------- <br /> ------------------------------------- ---------- - ----------------•- ...... --------------------------------------------------------------- ----------------------------------- <br />� <br /> FINAL'INSPECTION •BY:,.----t--."-------- 7 ---�-�"�-,.--..fi.,� Date------ --�-----------`'� <br /> f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F 130 South American Street ` 300 West Oak Street 132 Sycamore Street t <br /> Stock#on, California Lodi, California Manteca, California F <br /> 4 • EY-.•--9 '2M, ' 344446 ATWOOQ 12-54 <br />