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APPLICATION FOR SANITATION PERMIT Permit No. G.�.. _. <br /> (Complete in Duplicate) <br /> Date Issued .__.___��1-a__ <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 Ordinance No. 54�� 3 <br /> JOB ADDRESS AND. LOCATION /! <br /> Owner's Name-- �::------------- Phone--------------------- -------------- <br /> Address---------A� :25 ------------------------------------- <br /> Contractor's Name----=-- _ e- -- -------------•---------------------- ------------ Phone----------------------------------- <br /> lnsfalla+ion will serve: Residence [3' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i <br /> Number of living units: ....___. Number of bedrooms•.� Number of baths Lot size.-_.4 5_14-- _:--_-__. <br /> -------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to.Water Table Xe ft. I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeZ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No J9L _New Construction: Yes,_No ❑r + <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: T <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.). <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material _-_~_-'---.-----__._---_-------.-_---_---_.-_. . <br /> ❑ of compartments----- - ------------------Size------•-----•-------------------Liquid depth-----------=--------------Capacity-------------- -------- <br /> :1Fel : eDisposance from nearest well.................Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El N er of lines-----------------------------------Length of each line---------------_-------.......Width of trench-------------•----------------- <br /> Type of filter material-------------------------Depth of filter material---•..............----- otal. <br /> length,--------------------------------___-- <br /> ---- <br /> ' tande fpmou ' .------ Distance to nearest lot line- ZdSeep <br /> Seepage Pit: Distance to nearest D <br /> Number of pits... . ... Lning material--. a�eter � Depth-...--.x40------------- \� <br /> Cesspool: Distance from nearest well-----------------Distance from for ndation---------------.--- Lining material--------:-_--.-----.---._-.----_-----. <br /> ❑ Size: Diameter------ `-----------------------------Depth--------------------------=-------------------------Liquid Capacity----------------- -------gals. i <br /> Privy: Distance from nearest well.....................----------------------------Distance from nearest building <br /> Distanceto nearest lot tinge--`--------------------------• ----------------------------------•---•------------­---- •-----------•------------- -------------'---------- <br /> Remodeling and/or repairing (describe):-----ly--��__� ._ 1'7---------•-:-•--------------------- I - ------•------------------ <br /> ---------•---------------- <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 laws, and rules and regulations oftheSan Joaquin Local Health istrict. <br /> [Signet-v�__. _-..._ - - ------- 4 - Odwrier aYn`d�o <br /> { / r Contract <br /> By:_ = [Title) r- <br /> ----------------------------------------••---• ------ --------------- <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY.. <br /> APPLICATION ACCEPTED BY------------ --------------- ------ ---•------------------------------------ DATE- --- -r----•---------- ' <br /> REVIEWEDBY-------------------------- ---------- --- ------ - -------------------------------------------------------- DATE--jl, ---J._�J ---------- <br /> ----------- <br /> BUILDING <br /> PERMIT ISSUED--------------------------------------------------------------------------- -------------------------- DATE....------------------------------- ----------------------- <br /> Alterations <br /> -- - -•- <br /> Alterations and/or to ommendations:--__--- - ---- ------------------------------------ <br /> � a .---- --•.-1--------------1-1-1---------- <br /> ---------------------------------------------------- ---------------- - ------ % <br /> --------------------------------------------- ----------------------------------------------11------- <br /> -----------------------------------------...------------------------------- <br /> ---------------------------------------------------------------------------- <br /> ------------ -------- --------------- ------- <br /> ----- --------1111-- - --- -----------------------1111.- , <br /> -----------------------------------1111-• ------------1111.- <br /> ------------------------------1111-• -•--1111-- <br /> FINAL INSPECTION BY::----- - ------------------------------ <br /> SAN <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 /> E5—S 145446 ATWoq" # <br />