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dy APPLICATION FOR SANITATION PERMIT Permit No. 7___ <br /> (Complete in Duplicate) <br /> Date issued _____!___-;�______ka <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 /> JOB ADDRESS AND LOCATION_�: _�_'^_-e _S fi 1. �h, - --- <br /> -- 1r1 U a� . <br /> Owner's Name-------- ..... L— S , I ---—-----•• � �------------------------------------------------------ Phone------------------------- <br /> Address V --i ------------------ - <br /> Contractor's Name__-----•-_-------------------------------------------------------------------------------------------- -------__------ ...•- Phone----------------------------------- <br /> Installation will serve: Residence_E] Apartment House ❑ Commercial E❑ Trailer Court ❑ Motel ❑ Other 99--- <br /> Number of living units: ---L. Number of bedrooms __ ___ Number of baths J--- Lot size ______ __x____ -_r..3-_ <br /> _ -- --------------- <br /> Water Supply: Public'system ❑' Community system ❑ Private [grtspth to Water Table ft_ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam OR/Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No E3--New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank.or cesspool permitted i�po tywrwer is-available within 200 feet.)! <br /> .Septic Tank: Distance from nearest well_____`�_v_�_Distance from foundation___ ©--___-__--Material____--- ------------------------- <br /> No. <br /> "P No. of compartments--------.0 Size--------------------------------Liquid depth--------------------------Capacity---- <br /> -U'-D----- <br /> f _ t <br /> Disposal Field: Distance from nearest well `�" <br /> _ -_ -.-_Distance from found _� <br /> ation_ P.____.____.Distance to nearest lot line--..15— <br /> [� Number of lines------ �---� rt rr Length of each line__________-.--------------Width of trench-------- ----------------- <br /> Type of filter materiall__!`_?'.____-�!-_.__Depth of filter material ___-_l_S---------Total length-:--------&-U__________________ <br /> Seepage Pit: Distance to nearest wel!______________ <br /> --------Distance from foundation....................Distance to nearest lot line_______-_________ <br /> ❑ Number of pits---------------------Lining material-----------------------Size: Diameter------------------------Depth----_---------------------------- <br /> Cesspool: Distance from nearest wefl-----------------Distance from foundation---------------------Lining material_____________________________________ <br /> ❑r. Size: Diameter--------=----------=--------- Depth------------------------------ ---------------------Liquid. Capacity----------------------------gals. w} <br /> Privy: Distance from nearest well______________ ___________________________Distance from nearest building_-_____________________-__ <br /> ❑ Distance to nearest lot line----------------------------------- -------------------------------------------------------------------{------------=------------------------- <br /> Remodeling and/or repairing (describe): �GF �t --I I__------------------- �-•�G` --� fC —c- <br /> ---------------- !: <br /> ---'----•--------•--•-•----•---•------------•-••----:--•-------------------­-------- -----`-----------•---_-------•-------- ----- -- -------------------------------------------------------------- <br /> = - ----------------------------------------------------- -----•--•-------------•----------------------------------- <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 ws, and rules and regulations of the San Joaquin Local Health District. <br /> ---------_- -------- -----Owner and/or Contractor) <br /> (Signed)-- "� ----------------------------------- ( I <br /> #iy:.. - ==----- ----=_=------------------------------------------------------------==-------------=-=--=---(Title)-=----------------------=--- ------- - ------- -------- <br /> (Plot plan, showing sire 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. -- �y DATE -------- �-5----Y' - <br /> REVIEWED 9Y-------------------------------------- <br /> DATE-------------------- - <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations:----!---------- •------------------------------- -•------------------------•-••-•-•--••--------••-----------:------------------ <br /> ------------------------------•--•--•----------------•--------------------- ----------------------------------------------------- ------------------------------------•-----•------------------------------------------- <br /> -----------------------•------------ -- --------- ------------•--------------------------- ------- r--------------- <br /> FINAL INSPECTION,;BY ------- ---------^ ----------------- Date--- 't ! <br /> -------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> FS-4—?M ; Rnv:cnel W_?160 <br />