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fi APPLICATION FOR SANITATION PERMIT Permit No. __._".-�6 G <br />' (Complete in Duplicate) � ••"""'--'"" <br /> Data Issued i9" <br /> Application is hereby made to the.Sari Joaquin Local Health District for a permit to construct and install the wo <br /> rk herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION."" r <br /> Owner's Name------ ------ �".il"'2,�Q-_ai, <br /> -- -- ------ <br /> - ., <br /> Address <br /> .� ---- <br /> -- Phone--------------- -----•-----•---••--- <br /> ------•---•--------••-------•--•--------• ---------------------- --------------- <br /> Residence <br /> Name.."-_ <br /> - - ---------------- Phone-- <br /> Installation will serve: Residence --- -" <br /> ------------------•-- ---------------- •--- Phone-- --•---•----•-----•--•---------•- <br /> ❑ Apartment House [I Commercial <br /> Number of livingunits: _" ❑ Trailer Court E3 Motel El Other ❑ <br /> �""" Number of bedrooms __- umber of baths 1----- <br /> Lot size �� <br /> Water Supply; Public system ❑ Community system `"" <br /> ❑ Private. <br /> Character of soil to a depth of 3 feet: Sand *� Depth to Water Table ._"._"__ {t, <br /> Previous Application Made: yes ❑ Gravel [] . Sandy Loam Clay Loam ❑� Cla <br /> ❑ No � New Construction. Yes Q' No El' <br /> y ❑ Adobe❑ Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Y Distance from nearest well--_-,r?_ "--" <br /> No. of compartments"----_--- Distance from foundation_-- Material "1i�-C <br /> .Size------- - - <br /> �a - ----- quid depth_.- � ---------Capacity--- <br /> Disp Field: Distance from nearest well----,6..--,Distance from foundation-.--/.G'"'-_.._Distance to nearest lot line.Numberof lines_-."""""----" �l <br /> ----------------Length of each line---------3 -_ <br /> Type or` filter material"._"�-�+� ---------Width of trench_.--__-_"z•[�`�"- -. <br /> -------.-Depth of filter material.------/ '._ E------------ <br /> --""----Total length------------------- v------------- <br /> -- <br /> Seepage Pit: Distance to nearest well. _ Distance from foundation_"".."_" <br /> ❑ Number of Pits----------------------Lining material------------ --------Distance to nearest lot line"-______________• <br /> ---------.Size: Diameter -----. Depth- --------------------------- <br /> CesspooL Distance from nearest well-----------------Distance from foundation------------- <br /> Size: Diameter---------------------- ----- ----Depth--------- ------------------ Lining material----------------- <br /> F1 --------- <br /> Liquid Capacity ----------•--•- <br /> PrivY: Distance from nearest wolf _"--_--"_- --------------------------gals. <br /> -------.---_- "__.-Distance from nearesf buildin <br /> ❑ Distance to nearest lot line:------------------ g ---------- <br /> Remodeling -- <br /> emodeling and/or repairing (describe):--------------- ` <br /> -------------- I <br /> -•------ <br /> f hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County fv1 <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> _(Signed t <br /> ----- -------------------------------------------------------- --------(Ow <br /> By:._-•---------- ------a ---- a (Owner and/or Contractor) <br /> -------------•----- -------- -=--------------------------------------.------------.(rifle)--------- -----_- --------------- <br /> (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). <br /> _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> ------------------------ ----- DATE------ <br /> REVIEWED BY ................. ----- <br /> -- ------------------ <br /> ------------------------------------------------ DATE----- ---- -------- - ! <br /> BUILDING PERMIT ISSUED.-­---------------- <br /> -------------------------- -------- ------- DATE------------------------- - <br /> Alterations and/or recemmendatians:__..""_"-__-__._ ----- -- �-�------".-"._"_"_"_-- . <br /> ---- -------- ----- I <br /> -------------- ---------------------------- -•-------------------•------..---- <br /> -----•----•------------------------•----------- -------- --•---------------- -------------------- <br /> -- --------------••------------- ` <br /> ---------- <br /> ii <br /> FINAL INSPECTION BY: --�.�- ? <br /> _.. - - Date..... <br /> - <br /> 7------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 1 <br /> 130 South American Street 300 West Oak Street <br /> 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> • Tracy, California Is <br /> �`•-9—�M X146446 ATwoO 12-54 <br />