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5 <br /> �,P APPLICATION FOR SANITATION PERMIT Permit <br /> po ���So oar (Complete in Duplicate) <br /> Vol <br /> ��ti b Date issued y//_ s . <br /> a� � <br /> Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein 'described. <br /> This application is made in compliance with County OrdinanceJNo. 549.` Q- <br /> _ —• <br /> JOB ADDRESS AND LOCATION I.21"". _ L.� - .-------- ---- <br /> 1 1 - <br /> Owner's Name ��'R / .' QS - ------- - Phone ' <br /> ------- 77 <br /> Address--------------------------------------------------- � . ------- <br /> Contractor's Name =1 .l.c�' '__ ------ Phone ..�- _577�O------ <br /> Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of:living units: __l___ Number of bedrooms " :_ Number of baths '__/__- Lot size ._- ___------------------ <br /> Water <br /> _____________Water Supply: Public system ❑ Community system ❑ Private;K Depth to Water Table x'71 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 'Clay❑ 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 /> Septics T nk: Distance from nearest well-----------------Distance from foundation--------------------Material---------------------------- <br /> No. of compartments---- -----� ---Size--------- - - --- --------Liquid depth---- •-------_...Capacity -------.•/-.a4�►, <br /> Disposal Field: Distance from nearest well_,tQ Distance from foundatio Distance to nearest lot line <br /> Number of lines__ f..�._fit. _ Length of each iine._ � Width of trench /// <br /> Type of filter material -_ �__ - ..Depth of filter material----------------------Total length...._.. ........_ ._....___.._...... <br /> Seepage Pit: Distance to nearest well /`4C'©..__-__Distance fro fcun ation nearest lot Brag <br /> Number of pits_.. ..J----------Lining material Size. Diameter__.'_.3_ --------Depth -` ----------- <br /> Cesspool: Distance from nearest well________________•Distance from foundation--------------------Lining material-------------------------------------- <br /> Size: <br /> ' -- _-_- ____•__-_ _---_----Size: Diameter------------------------_----------Depth-----•---------- -- -----------------_Liquid Capacity .......:-- ----------..-gals <br /> Privy: Distance from nearest well _________________________________Distance from nearest building:_--------------------------.. .....--. <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------- -------------------------------------------- <br /> Remodeling <br /> --------------- - ----- --------- <br /> Remodeling and/or repairing describe):---_-.- - -_ <br /> -•-' -_ -• <br /> .............. _._.__ ._..... ..___ ...._..._ ...._.__. ... ..--._-. -_.....-_ --_----. ____--_. --.---__ _-----.-----____._--_ ---__-__ __-.__-_ ---------.---------- <br /> hereby certify that I v repared this applio06n and that the work will be done in accordance with San Joaquin County <br /> ordinan"es, S e laws; nd:rules nd re lations Ae San J, qwn Local Health District. <br /> v - <br /> (Signed)- --- s, __. ?12L� .` Contractor <br /> 7 <br /> -�--- -------- ----- -- ----- ----------------------------- ._(r+le) �1` it��... <br /> (Plot pan, sh`" ng size of lot, location Snfem in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.-Q. .. ......... - --------------- DATE_k, --------------------------------------------- <br /> REVIEWED BY ---- -- ---- --- -- DATE -- <br /> BUILDING PERMIT ISSUED---_ ___-----• ------ ------- ----------------------.-_. _-_-.---- DATE-------__ .; <br /> Alterations and/or recommendations- ---- --------------------------- ----•-- --..--..._ ...------• •----­----­----------------- ------ ----- .......................... <br /> FINAL INSPECTION BY:----W-- ------------------------------------------------ Date------q <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 /> ES-9-2M 8-51 Revised W-2100 <br />