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Permit No. <br /> 4 - APPLICATION FOR SANITATION.PERMIT .-$• - ._ _..___ <br /> (Complete in Duplicate) Date Issued <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 /> T <br /> —,JOB,ADDRESS AND' LO ION - ------------------------------------------------------------ <br /> Owner's Name- 6 •--------------- - Phone <br /> t ---------- -----•---- <br /> Address .. :. . ---•-•-.Z=. ------------------------- <br /> Contractor's Name------ -------------- ----------------------------------------------------- --•------------- Phone----------------------------------- <br /> Installation will serve: Residence Z_ Apartment House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of bedrooms _._o- INUmber of baths --._�_ Lot size ----._q _ .rte�!------------------------ <br /> Number of living units: /____ <br /> Water:.Supply: Public system 0__Community system ❑ Private ❑ Depth to Water`Table .Aft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2 Hardpan ❑ <br /> Previous Application Made: Yes ❑ Nom New Construction: Yes Eq_ No ❑ <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 ,f 4 Distance from nearest well------------------Distance from foundation--------------------Material----------------------------------------- -----. <br /> ❑ o. of compartments-------------- ------ ----Size-------•------------------------Liquid depth----------------- ------ -Capacity----------------------- <br /> Disposal Field: , Distance from nearest well=----------------Distance from foundation--------------------Distance to nearest lot line_.............. <br /> ❑ <br /> C,6umber of lines-----------------------------------Length of each line-----------.-.-......:---------Width of trench----------------------------------- <br /> rType of filter material-------------------------Depth of filter material --.------ .---------Total length---._-------_----____-._.-__-_--_--_-_-.-- <br /> Seepage Pit: Distance to nearest well.....A6?—L_Distance from foundation___/_ _.._.___.Distance to nearest lot line.... <br /> Number of p:fs..-.-./- -----------Lining material-_lFo, A __.Size: Diameter_--_-- Depth---------_12Q _-. ------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.................._Lining material-------......__--.-_--_-____--_-_ <br /> ❑ Size: Diameter-------------------------------------Depth-----------------------•----------------- - -I------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------------------------____----___.___.._--°Distance from nearest building-_.--...----_-----._-._-_-_-__.-----__.._. <br /> f <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------- --------------------------------------• --------------------------------- <br /> Remodeling and/or repairing (describe):--------- ----- ----------------------------------------................._--•-------------------------------------------------------- <br /> ------------------------------------ -----------------------------------•"-------------------••-------------- -----•------------------- ------------------------------------------------------------•------------------------ <br /> ------------------------•-•---•--------------••-----------------------------------------------------------------------------••---------------------------------------------------•---•----==-•------------------------•------- <br /> ;y <br /> ---------------------------------- ---•--•------------- _- y <br /> 4 I hereby certify that I have prepareclAhis application and that the work will be done in accordance with San Joaquin County <br /> -ordinances, Stat s, and rules and regulations of the San Joaquin Local Health District. <br /> C <br /> (Signed)--- ---- --------- ------------------pp---- ---------------------------------- -----.----------------- ----- - Owner and/or Contractor) <br /> By:. _ -- ­- -----4 w` --------------------------------------------•----(Title)---- -----------------•------ ------------------ <br /> t <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 /> APPLICATIONACCEPTED BY..-------------------------- - ----------------------------•-------=------------ DATE ���----------- ------------------------------------ <br /> REVIEWEDBY----- -------------------------------- ----- ------------ .------ -------- DATE - <br /> BUILDING PERMIT ISSUED----------------------------------- DATE -- - - - <br /> Alterations and/or recommendations:----------------- --- •--- <br /> -- <br /> e � ��s.X, lJ• -x�..@.�e..� •ay. , ----- -------------------------------------------------------- <br /> ---------- ------------------------------------------------------ --•----- ----- --------------------------- --------------------------------- -------------------------------------------------------------------- <br /> FINAL INSPECTION- BY: = - ----------------------------- Date - � <br /> I, <br /> to• ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Straet <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> G <br /> E,5-9 345446 ATW=D <br /> f <br />