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� L <br /> y APPLICATION FOR SANITATION PERMIT Permit No. _- - <br /> � <br /> (Complete in Duplicate) Date Issued _____A <br /> __3� <br /> *",plica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her m described. <br /> This application is made in compliance with C Ordinance No. 549. <br /> . <br /> JOB ADDRESS AND LOCATION------F41-- Urul.... --.a----------------- ---------------------------------------------------- <br /> Owner's Name---------------•-==----------- ------ ....Z_0--1,. -------- - ------------- --------------------- -------- Phone--- ��Q � <br /> Address-----•-•--•--------•-------- g-----------•------- ----am49----------- - --------- <br /> • r r /1 <br /> Contractor's Name 3----------- -------------------Fdr--1 1�- ----- n-cr------------------------------------------ Phone - fP- <br /> Installation will serve: Residencee-W Apartment House E] Commercial E] Trailer Court E] Motel E] Other E]Number of living units: --/__ Number of bedrooms--- Number of baths _7—_ Lot size ------------ <br /> Water Supply: sY stem X Community system ElPrivate ❑ Depth to Water Table =lir <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No$ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank:or cesspool permitted if public sewer is available within 200 feet.) <br /> is T Qk: Distance from nearest weli-----------------Distance from foundation--------------------Material------------------------------.__-_--_-------_-_. <br /> No of compartments--------------------------Size----------_ -•------------ ---Liquid depth-----------------------...Capacity----------------------- <br /> a al Field: �; Dist nce from nearest well.................Distance from foundation--------------------Distance to nearest lot line.----____--__--_- <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------------------:--:------� <br /> "`[[[ Type of filter material-------------------------Depth of filter material--------------.-------- otal length------------------------------------------ <br /> _. <br /> / D n <br /> Seepage Pit: Distance to nearest well_- Q1�@_____Distance fr m found ._ <br /> ation__ .._______.Distance to nearest lot line--- <br /> `CessIt Number of pits___.---- -----------Lining material& ------Size: Diameter----31"---------Depth--A;U----------------------- <br /> Cesspool: <br /> pool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____._._-_-__________-______.____-_. <br /> ❑ Size: Diameter------------------------------------ -Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.------------------------------------------------ from nearest building------------ ___-___-___.---________----. <br /> 0 Distance to nearest lot line.-------------- ------------------------------ --------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)----------------------------------------------------------------------------------•---------------------------------•--------------•----•------------•---- <br /> i <br /> r <br /> I hereby certify that I ave prepared fhis application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, a r les and regal ions of the San Joaquin Local ealt>7 District. . <br /> 1 . t i <br /> (Signed] -- -- - - ----------- Contractor] <br /> r <br /> By:--------------------------------------------------------------------------------------- -- -..-----' {TitleJ_;' .�_� ��}.���f�---------------- <br /> ---------------- - - - - - --- - <br /> (Plot plan, showing size of lot, location of system in relatio o wells, buildin ,'etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE % ----------------------------------------- <br /> REVIEWED BY----------------------------- ------- DATE-- Vt�-------------------------------- <br /> - <br /> BUILDINGPERMIT ISSUED----------=---•-------------------------------------------------------------------------• ----------- DATE------- �---------I-------------------------- <br /> Alterationsand/or recommendations:--------------------------------------------------..-------------------------------------------------------------------------------- <br /> ----------------------- <br /> --------------b---------------------------------------------------------------------------------------b-.-.-:--------------•-----------­----------------------------------- ------------------------------------------------- <br /> ------------ ------------ ---------------------------------•------- ------------------------------------------------------•---- --------------------- ------------------------------------------------------------------------ <br /> v1.�lillTL � - --------- Date---------------------------- <br /> FINAL INSPECTION BY:.------- - - - •------------------- --- --- -- ---------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> I` <br /> ES---9-2M � . Revised W-2100 7 <br />