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APPLICATION FOR SANITATION PERMIT Permit No. .--7.-7- <br /> --------------- <br /> (Complete in Duplicate) Date Issued --- <br /> *7 <br /> Applfca`{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 0 clinance No, 549. <br /> 0 <br /> JOB ADDRESS AND LOCATION.... Xr -(3-ej__-P ------- <br /> - ---------- ---- ----- <br /> Owner's Name----------------------------•------------_ --•--•--------------------------------9--------------------- ---- - ---------------------------------- -- Phone------------------------------------ <br /> Address------------------------------------- -------------------------- A- --- --------------------------------- -------------------------------------------------- <br /> — -------------------------- Phone----------------------------------- <br /> Contractor's Narne-_ ----------- <br /> Installation will serve: Residence y""Aparfi-nent House 0 Commercial E] Trailer Court (] Motel 0 Other 0 <br /> -----------­------------ <br /> Number of living units: I... ber of bedrooms -k5-- Number of baths __/--- Lot size <br /> Water Supply: Public system ;,��Community system El Private E] Depth to-WWafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel C] Sandy Loam Clay Loam 0 Clay [] Adobe E] Hardpan [j <br /> Previous Application Made: Yes [] No.�ew Construction: Yes Z-;No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is 8 I ---------- <br /> avail.ablewithin 200 feet.) <br /> fV/ <br /> * ----- <br /> Septic Distance from nearest well-- Distance, from fou*fion_A:�---------- er <br /> 1211 No. of compartments------- ------ Size- <br /> ---Liquid dep�h--- --- ....... ------ capacity------- ------ <br /> Dispose Distance from nearest well-_____....____Distance from foundation-41-4.. ...... I nce to nearest lot line. <br /> Disposal field: dfh of trench._ <br /> icifh of french----- ----------------------- <br /> Number of lines___.______ Length of each line--, 40--1 J, <br /> Depth of filter material---1- ------Total length------ ---------------------- <br /> Type of filter material--151 <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line_________-_____ <br /> II ❑ <br /> ine----------------- <br /> El Number of pits----------------------Lining material--•-------__ _.....Size: Diameter.----------------------Depfri...... ------------------------- <br /> Cesspool: Distance from nearest well---------w-------Distance from foundation---._.._.-____..._ Lining material__________________.____.____________- �; <br /> ❑ <br /> aterial------------------------------------- <br /> ElSize: Diameter------- --- ---------- ---------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy:' Distance from nearest well--------------------------------------------------Distance from nearest building---------------------------------_-_----_. <br /> ❑ Distance <br /> uilding----------------------------------W------ <br /> D;stance to nearest'"Iof line--------- ---- ---------------- ---------------------------------------------------W-------------------------------------------------- <br /> Remodelingand/or repairing (describe):--------------- - -------- --------------------------W-W--------------------------------------------_----------------------------------------------- <br /> ------------------------1-1---------------------------------------------------------------W----------------------------------------------------­-------------------------------------------------------------------------- <br /> -------------------------------------------------------------------11----------------------------------W-------------------------1---------W----------------------------------------­----W---------------------------- <br /> ----------------------------------------------- ----------------W----------------------------------------------------------------------W_W_----------------------------------------------------------------------------- <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. StateXIs rules and regulaflons of the San Joaquin Local Health District.,--, <br /> --- --- —--------------------------- ------------------------------------------(Owner and/or Conl_�torj <br /> (Signed)-----_------- 7, <br /> By----------------------------------------------------- -----W-------------------------------W----------------------------------------(Title)--------------------------------------------- ------- -------- <br /> (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FO E1311147 ME T DONLY11 <br /> APPLICATION ACCEPTED BY-- <br /> BY-- .1�4e47gl.�. ...... -E------ <br /> E------ - <br /> REVIEWEDBY--------------------w----------- - -- - - -- ------------- ---------------------------------- DATE --- <br /> BUILDING --------------------- <br /> PERMITISSUED------------------------------------------- ----------------------------------------- ------------- DATE-------- ---------------- <br /> Alterations and/or recommendations:-------------- --- ---------- ------------ - --------------------------------------------------------•-------------- Z-------------- <br /> -------------------------------------------- ------- --------------------------------------W-W--------------------------------------------W-W-------------_------------W------ --------•---------------•---•---------•--- <br /> ­_­------------------------ ------------------------ --- ------W.I----------------- ----------------------- -------W---------------------------------W---------- ------w------------------------------ ----- <br /> _ <br /> ---W <br /> --------------------------- - ------------------------------------------------------------------------------------ --------------------------------------- ------------------------------------------ -------- <br /> -------------------------------------------------------------- ------ ---- -__ --- ----------------------------------------------------- ------W------ - -- ------ ----------------------------------------------- <br /> i , , <br /> FINAL <br /> ------------W------------------ <br /> FINALINSPECTION BY:_------- - ---------------- --------------------------- Date----- -- -------------_----------------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfree,+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> � --r5­9-2m 145446 A7WOOD 12-54 <br />