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APPLICATION FOR SANITATION PERMIT Permit No. _2-.__1•______,!-_____. <br /> (Complete in Duplicate) y <br /> Date Issued __ __lly___ ____?.__ <br /> b <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. 544. <br /> JOB ADDRESS AND LOCATION ---------- --- - ------- I! <br /> Owner's Name---------- <br /> -- <br /> Address - R � �¢�------------------------------------------------------------------------------------------------------:--------•- <br /> Contractor's- Name----------------------------- / -�4 i. •C ----------------------------------------------------------- Phone--2y'v-4-y_�Pf 0-7 <br /> Installation will serve: Residence 0>-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , <br /> Number of living units: J___ Number of bedrooms - __. Number of baths _ _.: Lot size __._7 __ :d_______________________-- <br /> Water Supply: Public system Community system ❑ ' Private❑ Depth to Water Table _ya ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 .Sandy Loam ❑ Clay Loam❑ Clay [❑ Adobe EI-Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [�4— New Construction: Yes ❑ No 1� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S tic Tank: Distance from nearest well-------------------Distance from foundation__________________-Material-_-____-____._.___________.________..___..___._. <br /> .x <br /> No. of comartments__________________ <br /> p -- - ---Size-------•------------------------L-squid depth--------------------------Capacity-------"--------------- <br /> Disp*os I Rield: Distance from nearest well.................Distance from foundation-----------------_Distance to nearest lot line.______--__.-•-- <br /> Number of lines-----------------------------------Length of each line------------------ ------------Width of french----------------------------------- <br /> Type of filter material----------------„_,,__ll_---_-Depth of filter ma#erial-----------_----------Total length------------------------------------------ <br /> Seepage Distance to nearest wel(. Distance from.fo ndation___,/d__.___.--Distance to nearest lot <br /> l-7 ----- <br /> �y <br /> Number of pits._--_-�_._-.______.Lining material__F�-t-�z�..Size: Diameter_._.�,.�__...__.___.Deptn._._t��~ _____----------- <br /> Cesspool: Distance from nearest well________________Distance from foundation-----------.--------Lining material-------------------------------------- <br /> F1Size: Diameter---------------------- ---- ---------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Priv Distance from nearest well---------__-----__-------------------------------Distance from nearest buildin ` <br /> ❑ Distance to nearest lot line------------------------ ------------------------------------------•------------------------------------------------------•-------------- <br /> Remodelingand/or repairing (describe):-------- ------------------------------ --------------•--••-------------------------- ---•------------------------------------------------------•---- �' <br /> ----------•---------------------------------------------- ---------------------------------------------------••---------------._...---------------------------------------•---------------------------------- a <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 ry�les�and regulations of the San Joaquin Local Health District. <br /> (Signed) -•---------------� .----- ---------------F-------------- ----------------------------------(Owner and/or Contractor) <br /> BY= --Q-P-� ---------- = (Title) �— � <br /> (Plot plan, showing size of lot, location of system in relation to 115, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------- Z> --------------------------------------._ DAT - -•-••----------------------------------- <br /> --- <br /> BY------------------------------------------------------------ DATE r--- <br /> - --- <br /> BUILDING PERMIT ISSUED N= ---------------------------------------- • DA E-------------- ----�=--•------ <br /> Alterations and/or recommendations--------------- -------- -----`- -- --------- -----•--------------- ----------- <br /> -- --j <br /> FINAL INSPECTION BY------- -------- ------ ��� "--- f <br /> --------• --- ----- Date / ---- ---------------------------- <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, Californias Tracy, California <br /> E5___3 145446 PTwOno <br />