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J <br /> r 5 y �yp <br /> APPLICATION FOR SANITATION PERMIT Permit No, 1--�-• /_-_ <br /> (� <br /> v -IX <br /> 1,V <br /> / (Complete in Duplicate) <br /> '" Date Issued ___A/5_Y <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance <br /> No. 549. <br /> JOBADDRESS AND LOCATION-------(L ----- --------------------------------------------------------------------------------------� ---------,j-------- <br /> Owner's Name----------- �L. -w ----------- </!r '` GG`_---V.sr` Phone nC7 <br /> Address-------------------------------------f-_ ` 7 4"--` i <br /> -- --- -------------------- ------------------------------------------------------------------------- <br /> Contractor's Name---------------------------------------Alge-4,,-e------------------------------- --------------------------- Phone -------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms ___ —Number of baths -/---- Lot size ______74,_K_.8J"'_-_-_____ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ 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 K New Construction: Yes X No ❑ " <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well___ _-__-Distance from foundation--­/0---- <br /> ___.Materia--l_r-------- ______ <br /> No. of compartments________�_.______-___Size______= -- F-=�--- Lquid depth -' � Capacity-------�Off <br /> Disposal <br /> ' <br /> Field: Distance from nearest well________________Distance from foundation_____IQ_�______Distance to nearest lot line____ __ <br /> Number of lines______________________ _-_____Length of each line------------/---------------Width of french-----------Z_`_0_`4----------- <br /> . <br /> Type of filter material__�� ��_ Depth of filter material--------- --'/______Total length______________________�7,C)_______ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ <br /> ❑ Number of pits----------------------Lining material----------------_------Size: Diameter—----------------------Depth------------------------------_-- <br /> Cesspool: Distance from nearest well_________________Distance from foundation-----------------._.Lining material_________--_________________________ <br /> ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well------------------ ------------------------------Distance from nearest building_____________________-_-___-____-------_-. <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------- ----------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------•------------------------------------------------------------------------•--------------------------------------------------------- ----------------------------------------------------- <br /> ----------------------------•-------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------- -�s <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 ru and regulations of t San Joaquin Local Health District. <br /> (Signed)------------- --- ------------------ -•------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------- - -------- -------------- ------------------------- DATE------------- <br /> REVIEWED BY-------------------------------------- - - -- - - -------------------- ✓+-r►'-------------------------- DATE------------- <br /> Z <br /> z <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:---------------------------------------------- ---------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- <br /> -------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------•--------------------------------•----•-- <br /> ---------------------------------------------------•------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------- -------------- ------------------------------------ -------------------------------------------------- <br /> ( ' ;� <br /> FINAL INSPECTION BY:------------- -------------------- Date-----------= ---------------------------- <br /> or <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 /> i <br />