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APPLICATION FOR SANITATION PERMIT Permit No. ....... <br /> (Complete in Duplicate) <br /> Date Issued -F/rFp/.`?:_7 <br /> Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> r This application is made in compliance with County Ordinance No. 544- <br /> 1 JOS ADDRESS AND LOCATIO ._..... 4... ..,_ .--.--. 1 -_L• ---tilt__�s,_�t _. <br /> . .. ............ / <br /> Owner's Name..... .�}... ............. ris2,..� . - .... ---------------- -- . . .........--•---------- Phone.__ .... _,, y >� <br /> Address-----_----• ._ <br /> ------------------- --•------------------------------------------------------ <br /> Contractor's Name__._.L. E1,,-•-• _ 4.... ----------------- --- ---•----__ Phone ..3�f�l•� <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel�❑ Other ❑ <br /> Number of living units: - _.___ mber of bedrooms _ _ Number of baths ._1..._ Lot size --_f' -a_.....`+ _..__.�......................... <br /> r <br /> Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe[hardpan C] <br /> Application Made: Yes ❑ No Lv New Construction: Yes VNo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T n Distance from nearest well..................Distance from"foundation-------------------Material................................................. <br /> No. of compartments------- ----- ........ ---Size................................Liquid depth...----------.... --------Capacity.-..---------------•--- <br /> Disposal F' d: Distance from nearest well.................Distance from foundation....................Distance to nearest lot line................. <br /> Number of lines.............. ------Length of each line..............................Width of french------.----------------..---.------ <br /> Type of filter material...................• Depth of filter material__.--,-_....--.........Total length.......................................... <br /> Seeps it: Di stance to nearest well�.'...— _... __Distance from foundation-.� .Distance to nearest <br /> Dumber of Fts........1------..__.Linin material__. r......Size: Diameter._.._ ~ .._...De tn.... <br /> P g .... p <br /> Cesspool: Distance from nearest well------__.__._Distance from foundation._................ Lining material-.................................... <br /> ❑ Size: Diameter---------------------- ... .......Depth................................. ..................Liquid Capacity.................-----------gals. <br /> erivy: Distance from nearest well................._...._............ .........Distance from nearest building-------------.._. -_-._-_______._..___- <br /> ❑ Distance to nearest lot line................. --------------------- -------------------------------------------- •------••-...---•____............................. � <br /> Remodeling and/or repairing (describe):....... ------- e <br /> ---. •-•. -►K,--• <br /> I <br /> ..........--•----•-••..........................................••--------•---- ------• ------------a------------••---•-- ------------- ........................"­1.......W-------------- <br /> ------------------------------------------------------------------- <br /> ------•-------••--••............. ---------•-•--•-•-•----•----...--•-----•-_._...--------.--_..__....._------------...-_......._.._...._.............--••----....----------................--•------------------- <br /> i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordin ate laws, and rules and regulations of the San Joaquin Local Health District. <br /> [Sign d .-_-- .._.... ---------(Owner and/or Contractor) <br /> B By- <br /> (Plot plan, showing size o#, location of system in relation to wells, buildings, etc., can be placed on reverse ide}. /) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.V <br /> --• • ------- .............. DATE__...---•-------- --------------------------------=1 <br /> BY ... --•............. DATE .. _..._.... <br /> BUILDING PERMIT ISSUED-------------- -------------------- --•-••--------------•-•-----. ------------------------ DATE..........!�--------------------- ••-------------------. <br /> Alterati f nd/or jecomm ndafions:...._ ......... ............. ....... --- ----_-. _ -- <br /> ----------- ----- ----- <br /> .......... . ........ --....--------------------------------------------------_...._...:.....__...-----•......---......----------•---..........-...._..---•------------•---...------............----•----------- <br /> . ----------- --------- - --- - - - -------- ----------------.-------.--. .....-------------- ------ --------------- ---------------------------------------------------------..._...---•----------------------- <br /> FINAL INSPECTION BY:....... � �_:� '-------------------- ---------- Date_....I-. - !.. .[.`�'-.. ....._...... ......... -----. ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Street 132 Sycamore Strut 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> rr—9 Isaac Alw... <br />