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�\�u - <br /> APPLICATION FOR SANITATION PERMIT Permit No. _-- - -_ <br /> (Complete in Duplicate) v �l <br /> Date Issued _ l-�/,-4I.-1�_. <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 /> '" ....cThis`application is made in compliance with County Ordinance No. 547. ��Ji7e�u £ �� F <br /> 30 <br /> JOB ADDRESS AD LOCATION - l <br /> Owner's Name---f-•-------------------- ----------1 -�-� ------------------------------------------ <br /> -----------------••-•-----•-•---------------•-----....------------ -----------Phone---- -•------------------••-------.. <br /> ... -------------- <br /> Contractor's Name--- -- ----------------- Phon ''�^------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -_"'---Lot size ---- -----F-0--- <br /> Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table r!Z_ ft. <br /> Character of soil to a depth of 3 feet: Sand�avel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 6—New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> _..—:---� �-- -- -_.. - _ ._e4 <br /> -- <br /> Septic Tank: Distance from nearest well_�-- ----Distance from foundation-_-. .--.-_Materia-----------------------------_-- � W <br /> -- ----_-_--Size.. _A-`-`f-O- ---Liquid depth--- ------- -Capacity----- <br /> No. of compartments.. ---' <br /> 0 <br /> Disposal Field: Distance from nearest well¢.-(----Distance from foundation----L 6---.....Distance to nearest lot line----L).--...... <br /> �— Number of lines--------- -------------Length of each line------ Width of trench.2- -_�---.--.--.-----_-_ <br /> Type or filter material-_-.I- --.--- -_--Depth of filter material-.... - _._...- .Total length--..---�5.�---------------------- <br /> --- <br /> li <br /> Seepage Pit: Distance to nearest wef{ ---------------------Distance from foundation-------------------.Distance to nearest lot line--.-----._-._---. <br /> Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-------------------------------_- <br /> El <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------.---------Lining material--.-...-.----_.-------------------_-- <br /> Size: Diameter------ ----------------- ----Depth------------------------------------------------ ---Liquid Capacity----------------------------gals, .d <br /> I Priv Distance from nearest well-------------------------------------------------Distance from nearest building_--.--.-----.--------------_---.-_-----. <br /> [] Distance to nearest lot line-------- -------------------------------------- ---------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)-------------------------------------- -----------------•-------------------------------•----- •--- <br /> ---------------------•------------------------•------------------- ------------------------=---------------------------------- -- FA <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 of the San Joaquin Local Health District. e, <br /> &15r� -- <br /> (Signed)--- ---------- - ----- <br /> - Contractor) <br /> By:------ �-- 1 --- ----------------------- (Ti#le)---------- ------------------- ------- ------ ---------------- - _ _ .� <br /> - (Plot plan, showing size of-lot,location of system in relation fb7wells, building's, etc.;can be placed on reverse sidej. "~ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------- ----------- <br /> -------------------------------------------------------- DATE------- J-- -- --- ---- <br /> - - <br /> REVIEWEDBY--------------------------------- - --------- ---- --------- - -------------------------------.- DATE---------------------------------------------------------,-- <br /> BUILDINGPERMIT ISSUED---------------------------------- -- ------------------------------------------------------------- DATE---------------------------------------- <br /> Alterations and/or recommendations----------------- --------------------------------------------------------------------------------------------------------...---------------- <br /> ----------------- <br /> ------------- <br /> - •- <br /> - - ----- -•------•--------------- ------------•----•-------- <br /> --- � ------ ----------------------- ---------------------------------- <br /> ----------------- --------------------------------------------- <br /> FINAL INSPECTION BY.. ------------ ------------ Date...........� ---�=-T---.-17 --- ------------------------------------------------- <br /> - <br /> S <br /> ---------------- <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 /> E5-9-21W 145446-ATWC0P 12-54 <br />