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APPLICATIONfOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued _� _�_q___S3' <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 /> b <br /> JOB ADDRESS AND LOCATION______ _ 92P <br /> ------ -W- --� ------------------------------------------------ <br /> Owner's Name..... ... .. .. ------ --� - ---- Phone <br /> i �f f/� ------ <br />` Address-------------------------- <br /> �4 __ <br /> - ---- ------------------------------------------- - - ----Contractor's Name--------------- -- Phone ,F760 ---- <br /> Installation will serve: ResidenceApartment House E] Commercial F] Trailer Court ❑ Mote] ❑ ,yOther ❑ <br /> Number of living units: '/-- Number of bedrooms 1p_- Number of baths I----- Lot size ._ L�_e�_�,r� __________________________ <br /> Water Supply: Public system Rr Community system ❑ Private ❑ Depth to Water Table.?O- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M r Hardpan ❑ <br /> Previous Application Made: Yes ❑ No A New Construction: Yes ❑ No &r <br /> i 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 /> ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> Dispo al Field: Distance from nearest well_/*A/,X_.Distance from foundation_ j-_____Distance to nearest lot line__�4�.!-__-_ <br /> Number of bines---- __ _ -Length of each line:_ ___ Width of trench__ _ _ <br /> ------------------------ <br /> Type of filter material j��„_�,e0KDepth of filter material--_-___ __� __e__Total length___��"--------------------------- �•— <br /> //,,-, •'t—l <br /> Seeps a Pit: Distance to nearest we!!_�Distancrom foundation__S�'�_____.Dlstance to nearest lot line__-! __._--. <br /> OFf <br /> Number of pits_ _ <br /> / _____Lining material_ 1C .5ize: Diameter ,Vf,bjPepth_-_ Q_ ________________ <br /> Cesspool. Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> ----------------.-.----------------Li <br /> ❑ Size: Diameter--------------------------------------Depth----------------- quid Capacity <br /> ------------------ --------gals. <br /> Priv _ v . Distance from nearest well________________ __ _ ___Distance from nearest building y. <br /> ❑ - - ._ -- t <br /> Distance to nearest lot line______________________ - ---- -- - <br /> - - II nn <br /> Remodeling and/or repairing (describe):----- t --------- ------------------- -- ---------------*------------- ---------------------------------- to f <br /> � . , <br /> -------------------- <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 sand ules and reg.ola ions of the San oaquin ocal lth District. I <br /> I`: F <br /> 4 (Signed)----- ------- a-- -- -- ---(Owner ZAnrr Con actor) <br /> ---------------- <br /> By:----------------------------- � ----------- - ---------(Title)-------- <br /> - ----------------- <br /> (Plot plan, showing size of of, location of system in relation to w s, buildings, etc., can be plat on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> i1 <br /> APPLICATION ACCEPTED BY-------------- ----- k ----------------- -------------------------------------- DATE----------- —--------- <br /> REVIEWEDBY----------------------------------- -------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED------------------------ ---------------=-------------------- --------------------------------------- DATE----------------------------------- <br /> Alterations and/or recommendations:----------- -----------•----= ---------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------ ------------------ ----------- ------ ------------------------------------------------------------------------------------------------------------- <br /> - a <br /> ---------------------------------------------------------------------------------------------------- --- -------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------- -------------- ---------------------------------- ------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY: Date... ' - <br /> J, ----------------------------- <br />' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ' <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES---9--2M B-51 Revised W-2100 <br />