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4 ✓ <br /> _+ APPLICATION FOR SANITATION PERMIT Permit No. 0 <br /> (Complete in Duplicate) Date Issued _!_z/ -/ <br /> �i <br /> Applica4-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 compliance with County Ordinance No. 549. <br /> � , _o� --- � -- --- -•-- <br /> JOB ADDRESS AND LOCATION...--fi�Q- -- --- --------- ---- --- � ..."-- •-------------- <br /> Name L-e-k . --- ------------------- <br /> Owner's Phon <br /> ----- ` -k� �a_t <br /> :-_...--- ------------ <br /> Name ---•----- Phone <br /> 0 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court❑ Motel ❑ Other [I �. <br /> Number of living units __ <br /> : mbar of bedrooms _ Y- Number of baths .__/-- Lot size ...... <br /> �-_ .___.�-___rC1+�____.__ <br /> Water Supply: Public systemI Community system El , Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth!!of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loamyy❑ Clay ❑ Adobeardpan E]Previous Application Made: l�Yes E] No E�ew Construction: Yes El No ❑�[,,pwoly �)r-e7►ihdgcq <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ptic Ta k: Distance'from nearest welt_________________Distance from foundation--------------------- <br /> -Material_______.______.-_.._____..._._.-_--.-__-.______. <br /> 1 `n No. of compartments--------------------- ----Size--------------------------------Liquid depth------------------------- Capacity <br /> , <br /> s <br /> isposal Field: Distance�from'nearest wO-Ak_lk-._Distance from foundation....J.�l----D-sstance to nearest lot line___f_Q____. <br /> .aid 4-%4-i: Number:sof lines--- -------------r Length of each line_____; Width of trench-.: --------------------- <br /> Type of filter material_ Depth of filter-material---- ----..Total length-----7- --___________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot <br /> ❑ _ line_____________ <br /> Number.of pits______ ________ ------Lning material-----------------------Size: Diameter----.---------------- Depth--------------------_ ___.-__. <br /> X <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------- material__ .--.-___.--------------------------------- <br /> ❑ Size: Diameter----- ------------------- ----------Depth-------------------•----------------- <br /> Liquid Capacity ; <br /> - •Privy: = Distance from nearest well--- - -------------------------------------- ---Distance from nearest building----- - --------------------------- .f <br /> ❑ Distance to nearest lot line----------------------------------------------------------••-------------•--------------------------------=---------------------------------- <br /> 0 <br /> Remodelingand/or.repairing (describe):-------------------------- -----------------------------------------•---------....-.....----------•---••-----------------------------------­--------- 0 <br /> 1 -----•--------------------------•----------------------•-•---------------------------------•-•----- <br /> t <br /> ` ---------•------ ----------------- -•-------------------•---------------------------------------------------------------------------- ------------- <br /> ! hereby certify that I have orad this application and th work will be done in accordance with San Joaquin County <br /> ordinanc laws, and r es:a regu tio,e n Jo quin Local Health District. <br /> ( f_. n . ----- Owner and/or Contractor <br /> (Signed}.. `� ( / I <br /> ` I � {Title)-- J-------•----------------------------------- <br /> By--------------------------------- <br /> (Plot plan, showing size of lot, location of system in rela on f we11s, buildings, etc.,Lan be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> ~' ---------------- <br /> APPLICATION ACCEPTED BY------------ ----------------------- -------------- ------ DATE--------------------------------- <br /> REVIEWED BY----- --------------= DATE <br /> BUILDING.PERMIT ISSUED------••----•------------------------------- --------- ---------------------------------------------- DATE-...:�--------------------------­­------------------ <br /> Alterationsand/or recommendations:-------------- ------------------- -•---------------------•-------------------------------------------- Vk----------------------------------------------- <br /> - I <br /> ---•---------------------------------------------------------------------------------------------------------- ----- <br /> ----------------------- ---------------------- ------------------------------------------- <br /> 1 <br /> ------------------ --------•-------------------------------------- <br /> 'i C <br /> FINAL INSPECTION BY:-------- ----------------------------------- Date- ------ <br /> J <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Amerkan Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-4-2M 145446 ATWVnD 12-54 <br />