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6 141(16 <br /> APPLICATION FOR SANITATION PERMIT Permit No. _S1,4..� <br /> (Complete in Duplicate) <br /> Date Issued .............��.. <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 compliancewithCounty OrdinannccePo. 549 <br /> - . <br /> JOB ADDRESS AND LOCATION--f_.f_7___ __-c� _.._ �f == � ......................................................... ......... <br /> Owner's Name------..... '-----•---- ---------------------------- ------------ --- ---------------------- ----------------- Phone.................................... <br /> Address............... 11�1 -------------------------------•----------------------- . <br /> Contractor's Name....................xle7_ ............ '-------------•---------- Phone................................... <br /> Installation will serve: Residence @a"-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---/-- Number of bedrooms .R... Number of baths .�-_- Lot size .._70 ...... le_________________________ <br /> . .. � <br /> Water Supply: Public system A -Community system ❑ Private ❑ Depth to Water Table lel, 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 2]` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> �'ptjp,Tank: Distance from nearest well__.______________Distance from foundation-___.-__---_-_____..Material........._________.:_ <br /> No. of compartments-------- -----------------Size--------------------------------Liquid depth------_- --------Capacity-- <br /> Disposal Field: Distance from nearest well.AUr Distance from foundation fey Distance to nearest lot <br /> [ ^ "' Number of lines---------/________ ___-__ Length of each line.__�l `_ _ __-__-.Width of trench._._.. _ <br /> Type of filter material..��'-_/L'?Pk� Depth of filter material____ _`________Total length_._..._._ ;; ................. <br /> eee a Pit: Distance to nearest - _ : _ _ Distance from foun ation. <br /> `.....Di tanco to nearest to line <br /> Number of pits. ___1 ___Lining material__ �__ _Size: Diameter---:��---_-____Depth____- --�_. ___-_•--- <br /> Cesspo - Distance from nearest well-----------------Distance from foundation-----------------_Lining material-------------------------------------- <br /> EI <br /> _ .-___._-____-____-.---_ --_----.❑ Size: Diameter--------------------------------------Depth----------------------------------------- ----Liquid Capacity............................gals. <br /> Privy: Distance from nearest well __--_--____-------------------------------------Distance from nearest building------------------------------------------F1 Distance to nearest lot line----- ---------------------------------------------------- --- ------------------------------------------------------ ......... <br /> Remodeling and/or repairing (describe):-______ __. I -_-.____ / u ..��_ ,11.t �...._.___. ; -.. ) <br /> f----- <br /> -----.---•- ------••----------- <br /> _ - • - - ------ <br /> - -- ------ --- - ---- -- <br /> -- -------- ----- -- --------- - ---------- ---- -------------------------------- <br /> I hereby certify th 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. <br /> (Signed)........... .le.------h'_ P1_/ /' SUr/lc E- ------------------------------------------------ <br /> (@1La Contractor) <br /> f � J <br /> By-...........................................f -- <br /> ------------_ --------------------....(riifle) �''4 ----------------- <br /> (Plot plan, showing site of lot, loc n of system in relation to wells, buildings, etc., can be pla�on rev side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- -------- -------••----------------------------------- DATE __-" -•------------ <br /> REVIEWEDBY------------------------------- - -------------------_---•--•-----•-•------• DATE------ --®------------•----............................. <br /> BUILDING PERMIT ISSUED............. - DATE----.�- .._..--... ..----- --------- <br /> Alterations and/or recommendations______________ <br /> ---•-•------------------•---------•-------------------------\ .1•.............-..................................................................................>................................ <br /> .......................................................... •--•••------•----------------•---------...-------------•••-••••-•-•---------•--•-••.....-•----•--•••••-•-••-----•--••••-•-•---••---•-...--•••----•••--•--••--•---- <br /> -----•-------------------------------------------------•---------------------------...--------------- -------------------------------------- <br /> -----------•-----------•-----------------................................................ <br /> L.t- <br /> FINAL INSPECTION BY: !? ' ._.... 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, California Tracy, California <br /> ES-9 145446 ATWOOO <br />