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,p APPLICATION FOR SANITATION PERMIT Permit No.:�F?-_'71...4---- <br /> (Complete in Duplicate) Date Issued-?I- A_4V5-1— <br /> Application is hereby made to the San Joaquin Local eaI District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County rdin�ne',No. 549. <br /> !--- -- -------------------------------- <br /> JOB ADDRESS AND LOCATION <br /> �' <br /> ------- <br /> Owner's Name - -'� ---------------- Phone------------------------------ <br /> j-_Z <br /> ---------------------------_.. <br /> T -- - ------------- <br /> Address---------- <br /> _Z� <br /> Contractor's Name Phone----•------------------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot_I O h Qrt& R <br /> cc <br /> Number of livingunits: __I____ umber of bedrooms _Z_ Number of baths ___I___ Lot size _C`J- -`---------�� ----------- <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 E] Sandy Lo;/No <br /> Clay Loam El Clay ❑ Adobe Hardpan F]Previous Application Made: Yes E] No New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public s wer is available within 200 feet,) <br /> et,) o ` <br /> Septic ank: Distance from nearest well_ag 0_�istanje fryofoun�ition______U______--_-Mate/rpli __--_ ______________ =__:__.,_r_�____. <br /> p �C/-- ----Size��._x_ 1-_X_!� quid depth----------?�-----------Ca aci L <br /> No. of com artments-------_ Li P tY <br /> -----Distance from found i Distance to nearest lot lin <br /> Disposal Field: Distance from nearest well o�.p__- � � t --'•-------' <br /> Number of lines__________ _ _ - �ngth of each line ---_"-��Width of trench_______.__ ?" <br /> r-. 7 ------------------ <br /> Type of filter materiafe ___Total length______-___ __ -------------------- <br /> Seepage <br /> ___ ._ <br /> -- -- pth of filter material--------.�__-�- - � -------------- ---- - <br /> Seepage Pit: Distance to nearest well--------------------_._Distance from foundation--------------------Distance to nearest lot line______________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material --__________---_________._.._.__---. <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- <br /> gals <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building___________-__________-----______------_. <br /> ❑ Distance to nearest lot line---------------------- -------••---------------------------------------------------------•------------•---------------------(� <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> - - ---------------------------••----------------------------•------------------------------------------------------------------------------------------- <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 /> (signed) � --------------------------------------------------------------------(Owner and/or Contractor) <br /> I ' ' <br /> By:-----------------6/--•-•.-------­------------- ------------------------------------------------ Title <br /> ------------------- ----- -- <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--------------------------------- <br /> - --- --- ----- --------- ------- ---------- ------- ------------------------ DATEE-------e ------------------------- ----------------- <br /> BUILDING PERMIT ISSUED------------------- <br /> ------------------------------------------------------------------------------- --------- <br /> DATE � ------------------------ ---------- <br /> Alterations and/or recommendations----------- ----------------------------------------------------------------•----------- ---------------------------- <br /> ---------------•---------------------------------------------------------- - ---------------------------------------- ------------------------------------------------- --- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- <br /> ---------------------------------------------------------------------------------------------------------- <br /> ----- ------------------------------------------------ - <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-9-21v1 8-51 Revised W-2100 <br />