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Permit No. ......q <br /> 'APPLICATION -FOR SANITATION PERMIT --- ---------- <br /> (Complete in Duplicate) Date issued -/p-.-/_ <br /> Alication is hereby made to the San Joaquin Local He - <br /> Health District for a permit to construct and install the work herein described. <br /> pp <br /> . <br /> This application is made in compliance with County <br /> Ordinance No. 549r <br /> ------------------------- <br /> 0-- --------- <br /> ------- <br /> - ---------------------------------------------- <br /> JOB ADDRESS ANDV'L CATICN­-----!1?__r---- ---- <br /> -------------------- <br /> Phone------------------------------------ <br /> ------ -------- <br /> ---------- ------ ----- <br /> - --------------- <br /> Owner's Name--------- ---------------------------------------- <br /> Address. -------------------------[__ •-----------� - --- Phone----------------------------------- <br /> I - I ------------------------ --------------------------- <br /> ----------r---------- <br /> ------------ <br /> Contractor's Name------------------------------- <br /> Installation will serve: , Residence I partment House [I Commercial [] Trailer Court [] Motel C3 Other <br /> Number of living units: --j_- 'Number of bedrooms I--�-- umber of baths t----_' Lot size ......b_(.o--- - ----- <br /> �1 p-15—ep—th to Water Table -------- ft. <br /> upply: Public,system El Community system 0 Private <br /> Water S I <br /> Character of soil to a depth of 3 feet: Sand F1 Gravel F1 Sandy Loam 171 Clay Loam El Clay El Adobe Ej <br /> : Yes 4j-,K-0 ❑ <br /> Previous Application Made: Yes E] No Lj___New Construction <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ibli sewer is available within 200 feet) <br /> (No septic tank or cesspool permitted if pi Materia.1.4;,,L---------- ---------- <br /> Distance from fou0a <br /> - _- i - ------9_04� <br /> Tank: Distance from nearest well-_11---------- t ---- I <br /> Size... --S-k tion---1-i fl� Capac tyOps <br /> Sep�k [do. of compa'rtmen[s---Se!--------------- -------Liquid d P*-Distance to n-earest lot line- <br /> nearest well_'_�v._Z)------Distance from foundation <br /> Width of trench-__.. ._ ----------- <br /> ` <br /> rench_ 1-4----------------- <br /> T__ _10 <br /> Disposal Field: Distance from ... ---Y <br /> of each line--J <br /> Number of ------------ material---- ------Total length --------- <br /> Type of filter material--- .T Depth of filter <br /> See p�q 'Pi.t: - D;slance to nearest well-----------------------Distance from foundation------------------- Distance to nearest lot line---__--_-----_-.. <br /> _Liningjj�aterial---------- -----------.Size: Diameter---------- ------------Depth-.----------------------------- - -41., <br /> F1 *materialg --------- <br /> Distance from' nearest well-----------------Distance-from'foundation------------------- <br /> Cesspool: Size: Diameter----..� -----------------------------------Depth------------:L------------------:------------- ­Liqu;d CapacitY----------------------- <br /> ElI nearest building----------------------------------------- <br /> Privy: Distance from.nearesf well._-._----------------------------------- ___--._Distance from <br /> ---------------------------- <br /> ❑ <br /> Remodeling and/or repairing (describ --- ----------- <br /> Distance to nearest lot line---------------------------------------------------------------------------------------------------- <br /> . I I -------------------------- ------------------I--------------------- ---------------------------- <br /> e):--------------------------------------------------- ------ ------------------------------------------------------------------------------ ---------- <br /> --------------------------- -------- <br /> -- <br /> ------- ---I---------_------------------- - ---------------------------------------------------- ­--------------------- --------- <br /> ------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- --- ------------- <br /> ------ ----- <br /> ----------------------------------------------------------I--------------------------------------------------- --------------------- __ <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 rules and regulations of the San Joaquin-Local Health District. <br /> • 4 -----------------------------------------------------------------(Owner and/or Contractor) <br /> $s ned ------- ------r--------- Y <br /> V <br /> --------------------------------------------(Title)---------------------------------------------------------------- <br /> By:------_--------- ------------------- --------------------------------------------- buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot. location of system in relation to wells, <br /> FOR DEPARTMENT USE ONLY <br /> -I - ---- --�-7-3---.-- t - - ---------- <br /> I <br /> -------------------------I------------ <br /> DATE----- Z - -- ------- <br /> APPLICATION <br /> ACCEPTED Y- ----------------- ------- ------------- -- DATE-------------------- <br /> REVIEWEDBY--------- ---------------------------------- --------- --------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED_.---.•---------1 ----------------------------------------------------------------- ---------------------------------------------------- <br /> Alterations and/or recommendations*-------------------------------- ------------ --- ---------------I--------- -------- <br /> ---------------------------------------------­- ----------------- ------ ----- ------------- --------------------------------------------------------------------I---------------------------------------------- <br /> ------------------------------ -------------------------- ------ <br /> ------------ ---------- ---------------------------------------------------------------------- <br /> --------------------------------------------- --------- ------------------------------------- ----------------------------- -------------------------------------------------- <br /> ------------------------------ ------------------------------------ -------- .--•_-_----•-----------..-.._.-_.-------- <br /> _ -----------------------------Z-------------- <br /> --------- ------------------ --------------- <br /> ------------------------------- ---------------------------------------- -0 <br /> Date---------------r;��11" ----------- <br /> FINAL INSPECTION BY---------------------------------------------------- ------------ ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street -132 Sycamore Street 814 North "C" Street <br /> 130 South American Street Lodi, California Mante-ca, California Tracy, California <br /> Stockton, California <br /> 4 ., <br /> ES-9-20 10-52 Revised W-2100 <br />