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APPLICATION FOR SANITATION PERMIT Permit No. ------- <br />(Complete in Duplicate) Date Issued - <br />A <br />�plica-lion is hereby made to the San Joaquin Local Health District for a per it to construct and install the work herein described. <br />This <br />application is made in compliance with County OrcliDaye No, 549. <br />JOB ADDRESS AND LOCATION W - -------------------------------------------------------------------- --- ----------------_---- <br />-------------- <br />Owner's Na - ----- — ------- -------------------- ------------------------ ----------------- .__ Phon7e - - ---- _Z, 7 <br />AAA-- <br />----------------------- -------------------------------------------------------- I ......... <br />Contractor's Name_ Phone. <br />e� ---------------------------- ; ........................... ................ <br />Installation will serve: R ence I <br />esid A,�Ej'* Apartment House [:] Commercial [] Trailer Court El Motel C] Other ❑ <br />Number of living units: _/ ------ Number of bedrooms Z. Number of baths _ i___ Lot size ---------------------------- <br />Water Supply: Public systemx Community system El Private E] Depth to Water Tabl ft - <br />0111 -0 <br />Character of soil to a depth of 3 -feet: Sand E] 0 Gravel [] Sandy Loam E] Clay Loam E] Clay E] Ad Hardpan E] <br />Previous Application Made: Yes [] N0)9� . 'New Construction: Ye>K No F-1 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septi a n kx Distance from nearest well --------- ------- Distance from foundation -------------------- Material ------------------------------------ <br />4r _;__ -- <br />----- <br />No. of compartments -------------------------- Size ---- I --------------------------- Liquid depth--------------------- ---- Capacity ----------------------- <br />Disposal, "Jo .sa] , F 01 old: Distance from nearest weIJ -------- 1 --------- Distance from foundation -------------------- Distance to nearest lot line_______.._______- <br />Number of knes ----------------------------------- Length of each line ----------------•------------- Width of trench-----•----------------------------- <br />_ <br />Type <br />rench--- ------------------------------- <br />Type of filter material -------------- ----------- Depth of filter material-.______.____..______. Total length_____-__._________._______________________ <br />See <br />ength----------------------------------------- <br />Seepape Pit: Distance to nearest well_,v-L-t07'____Distance Wm - f�o dation___ --------- Distance to nearest lot line ----- -- --------- <br />Number of pits.../________________ Lining material_&/'a" of er_,;%:�. 4 .......... 7 Derth_AX__1 <br />V 1)) <br />>�_ V ------- �! <br />Cesspool: Distance from nearest well-___.---- from foundation -------------------- Lining material_____.______________._ ---------------- <br />Size: Dia mete r- ---- — ----------------------------­ Liquid Capacify_-.:777:--_--— ----------- gals. <br />--- ----- <br />Privy: Distance from nearest well ------------------------------------- <br />----------- Distance from nearest builcli�6 ---" - ---------------------------- <br />❑ Distance to nearest lot line N <br />......... ------------------------------------ ---------------------------- - - -- --------- <br />-- --------- <br />- ---------- ------------ ---------- <br />Remodeling, and/or repairing (describe}:_-- 4*4 <br />--------------------------------------------------------------------------------------- --------------------------------------------------------- ------- --------------------------------- <br />--------------- <br />------------- I ------------------- <br />------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ •Z ----------------------------------- <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 Sate laws,,d-ndreu"Ies and regulations of th6 San Joaquin Local Health District. <br />W <br />-•-- ---------------------------------------------------------------------------------- ---(Owner e!§r Contractor <br />---------------------------------------------------------------------------- -------- <br />(SignE By: .... --------------- of lot, (Plot plan, showing si of lot, location of system in relation to wells, buildings, etc., can be P[4ifd on reveie�e siidi7.5� <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY--- ------------ -----------I------------ ---------------------------------------------------------- DATE <br />- — --------------------------------------------- <br />--- * -------------------- <br />REVIEWEDBY---------------------------- -- - -------------------------------------------------------------------------- -------- DATE----- <br />------- jK_ <br />BUILDING PERMIT ISSUED --------------------- - DATE ------------------------------------------------------------------------------- <br />Alterations and/or recommendations: ------- --- - — ------ ---------------------------------------------------------------------------------- 1-1 ------------------------------------------ <br />----------------------------- ------------------- ------------ --------------------------------------------------------------------------- ­ ------- ------------------------------------ ­ -------------------------- <br />------------------------------------------------------------- ------- -------------------------------------------------------- --------------------------------- ------ --------------------------- -----------------­-- <br />----------------------------- ------------------------------------------------------ ­ ------ ---------------- ­­­ -------------------------------- -------------------------------------------------------------------------- - <br />--------------- ------------------------ -- ---------------------------------------------------------------- -------------------------------------------------- �f --------------------------------------- -------------- ... <br />- <br />FINAL INSPECTION BY ------------------------ ------------------------------------------ Date ----------------- <br />-------------------------------------- <br />130 South American Street <br />Stockton, California <br />ES -9-2M Revised W-2100 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Lodi, California Manteca, California Tracy, California <br />