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APPLICATION FOR SANITATION PERMIT Permit No. . _U` _f <br /> (� l (Complete in Duplicate) <br /> Date Issued <br /> !I / <br /> Application 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----------- Sam Me ---••----------------------------------------------------------------------------------------------•-- <br /> Owner's Name------------------------VI C......pr laze--------------------------•--------------------- ---------------- ---------------------- Phone------3--_51024----•-------- <br /> Address.........._--------•----------say e } <br /> ------------------------------------------------------------------ <br /> Contractor's Name--•--•--•-------II---1?elta----------------------------------•------- ------------------------------ Phone----._3-3-955------------ <br /> Installation will serve: Residence ❑K Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units:IN ----1- Number-of bedrooms __2__ Number of baths -3----- Lot size ___ Q_-_X-__115---------------------------------- <br /> Water Supply:- Public systen­Ejc Communify system ❑ Private ❑ Depth to Water Table __2.5 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑X Hardpan ❑ <br /> Previous Application Made:.,Yes ❑ No a New Construction: Yes F&] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance ,from nearest well_________________Distance from foundation--------------------Material---------------------------------------------- <br /> --- <br /> ex iMt Ing No.. of compartments------------- -----------Size----------------------------`7--Liquid depth--------------------------Capacity---------------------- <br /> Number from nearest well-----------------Distance from foundation-__--_-.__-__;____-Distance to nearest lot line----------------- <br /> eXifIng 01 lines-----------------------------------Length of each line-----------------------------Width of�trench------------------------ -------- 1� <br /> Disposal Fie Distance <br /> 9 Type or .filter materia#________________________Depth of filter, material----.----__-'�"Total`lengw---._-.---___-__________________________- <br />} Seepage.Pit"" Distance to nearest well----110-------------Distance from foundation___._ <br /> - ----------Distance to nearest lot line__'�'_"' l <br /> :. Number of pits- ------Lining mdteriaL:b_r_I'r_k.7__.Size:Diameter--..-3_t______________Depth-----061.-_E------_-,----- <br /> Cesspool: Distance from nearest well---------------_-Distance from foundation---------------------Lining material_ <br /> itSize.,Diameter--- -------- ------ .—.-,---Depth --=-�°--`------------------------ ----- Ca acitY- ----- <br /> -------------gals. <br /> Privy: Distance from nearest well------------------..----------------------------Distance from nearest,bdilding-------------------------------------- <br />' ❑ Distance to nearest lot line "' ` k * ` <br /> ------------ <br /> I I <br /> Remodeling and/or repairing (describe):--------- -----YQrt---------------------------------------------------a•-------------------------------- ---------------------=�------- <br /> 1 ----------------------------------•--•--- 7 --•---------------- --- -------------------------- --•----•------------------------------ ------- ----- <br /> i <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 laws, andrules and regulations of the San Joaquin Local Health District. <br /> ¢i `% e <br /> (Signed) DeltA ----.nr--x-------------------------------------------------------------------------------- ----------- - -- ----------- ---- Owner and/or Contractor <br /> By: --------••-----•-•------ --Perm---YZart_han--------------------------------- ___ (Title)----------Gen_-Jigs.--------- -------- <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 /> M <br /> APPLICATION ACCEPTED BY-- Y9✓'.i f --------------------------------- DATE------------ - -- _1. ------------------- <br /> REVIEWEDBY-------------------------------------------- ---------------------- -------- DATE------------- ----------- --- <br /> BUILDING <br /> - <br /> ------------------- ---------------------------- <br /> BUILDING PERMIT ISSUED-A-------------- --------------------------------------------------------------------------------- DATE---------------------------- ------------------------------- l <br /> Alterations and/or recommendations:-- ---------- - ----••--- '-------.......--- -•---------•------------•-----`---------------------------------------- <br /> --------------------------------------------------------------------------------------------------------•-------------------•--- <br /> i <br /> -----•---------•--------------•---------------11--------------------------I----------­--------------------------- ---------•----------------------------------- <br /> FINAL INSPECTION BY:.-'----------- ---- - ------------------------------------- Date--------�-J- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 'W Sycamore Street 814 North "C" Street <br /> Stockton, California II Lodi, California Manteca, California Tracy, California <br /> I <br /> ES—.9-2M 10-52 Revised W-2100 <br />