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APPLICATION FOR SANITATION PERMITtf permit No. ---- -- <br /> (complete in Duplicate) Date issued .. ....... .. <br /> 5 d. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein cle cribe <br /> This application is made in compliance with County Ordinance No. 549. <br /> eIL <br /> ----------------- <br /> JOB ADDRESS AND LOCATION-. Phone- ----------------------------- <br /> ----------- <br /> . ......... .. .... <br /> Owner's Name----- ------------------------------- ................. <br /> Address...-..-. ---- ------ ----- ---------- Phone------------------------------ <br /> - -------- <br /> Contractor's Name-------------- Commercial V--orrailer Court [I Motel Other 0,, <br /> Installation will serve: Residence M Apartment House ------------------- <br /> Number of living units: ------- Number of bedrooms ___ Number of baths Lot size <br /> Water Supply: Public system El Community system 11 Private [] Depth to Water Table ----- ft. Hard an [3 U1, <br /> Character of soil to a depth of 3 feet: Sand C] Gravel [3 Sandy Loam [I Clay Loam Q;Zclay 0 Adobe❑ He <br /> Previous Application Made: Yes [] No F1 New Construction: Yes [] No F1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: sewer is available within 200 feet.) <br /> (No septic tank or cesspool permitted if public terial---C e, <br /> ---------------- <br /> well ,6 - ----- <br /> Septic Tank: Distance from nearest -Distance from foundation--&-_ Ma-!., Capacity-AloN------- <br /> Size.j- �x quid dep�h _ - <br /> trl� No. of compartments-- 16�tK --- C�Yti t- nearest lot line...AS-- <br /> Disposal Field: Distance from nearest we1i..,S__V_ Distance from foundation__J.�........Distance to ne ...... .I� <br /> es of trench- -----_----------------- <br /> ...... -- -- ------ Length of each line/ <br /> 9?1� Number of lines_-. <br /> length-----JY-- ------------------- <br /> Type epth of filter material <br /> Type of filter material---1%;.. -- �---- <br /> Seepage Pit: Distance to nearest well. ------------------Distance from foundation................_..Distance to nearest lot line_. <br /> F1 Number of pits__-...----_-.- .Lining material---------- ------ -- Size: Diameter------------- ------- -Depth-. <br /> Cesspool: Distance from nearest well- --------------Distance from foundation_ ____ --- - -Aining material-- --------- <br /> Size: Diameter----- --- ------ - - ----- Depth------- - ------------------- ----- --------__...._Liquid Capacity.._-----------------------gals. <br /> 11building_-.__-._--------._..._..-._...--.. <br /> Privy: Distance from nearest well.__ ---_--------------Distance from nearest <br /> r_1 Distance to nearest lot line._.__._._.-_-.-_.--- --- -------------­---­---­------------ ----------------------------- <br /> Remodeling and/or repairing (describe):--------- --ale-f-J.-l ----_-----------_--------------------- <br /> --------------- <br /> ----------------------------_------------------------------------ <br /> ..........................----------_-----_------------------------------------------------ --- a� <br /> --------------------------------------------I--------------I-------------- -------- ------------_------------------------------------------------11---------------------------------------- ----------------- <br /> - -------------............I--- --- ---------------------------------------------- I------------------ - -------------_--- -----------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 /> -----------------4CW~-�Contractorj <br /> ............. - ------- ----------- - <br /> (Signed)...... <br /> By:------------------------- -- - ------- --------------------- ----------------.(rltle)---.__7 -"a a <br /> (Plot plan, showing size of lot. 10 on of system in relation to wells, buildings, etc., can be placed on <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY,;----------------- --- - ------ -- --------------- -------------------------------------- DATES ------------- --- - ---------------------------- <br /> REVIEWED BY------------------------- ----- ---------------------- DATE----- <br /> � _N-- - - -- - - --------- --- ------------------ 0;---- - ------------- ---------_--_-------------- <br /> BUILDINGPERMIT ISSUED----------- --------------------------------------------------------------- ----------------- DATE-- :;e;�--------- ------------------------------------ <br /> Alterations and/or recommendations:_..----------------- ------------------- ---------------------------------_-...I..... ---------------............... <br /> ---------------------------­ �------------------------------------ ---------------------------------------­­------------------------------------------------ ..........I__..............­­­ <br /> --------------------------­---------------- ------------------------------ --------------------------------------------------------.................................................------ <br /> - <br /> .......... ------ ----------- -------------­----------­---------------­-------- -----------------------...... ------------------------------------------------------_----_------------------­-------- <br /> ----------------- ------- ---------------­.... .......... . -------I-------- ­­............... ----------------------------------------------------------.......... <br /> Date 41-o --- - ---- -- ------------ .......11--------------- <br /> FINAL INSPECTION BY:---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American S+,..t 300 W.0 Oak Sf,--+ 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E^. -.M ATW... 12 <br />