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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Gate Issued <br /> SLANNE <br />/Aglical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and -install the work herein described. <br /> Tapplication is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATIO _______________---�4 ------ <br /> - ------- --------------------------------------I--------------------- = <br /> Owner's Name. . ----------- - ---- ' _ P�hone--� ! <br /> -Address---------------_------ � /1 ^ � -�------------- ------ -------------_---------- -------'--- ------ <br /> - --- f/--S------ <br /> -- <br /> Contractor's Name----=------- ------------------------- ---- -------- ---------I--------------------------------------------­---------------- Phone---------------------------------- <br /> Installation will serve: Residence//„0_"Apartment House [I Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -./_____ Number of bedrooms s. __ Number of baths .-/___ Lot size -----_-Z--- �Z__Q---------________________ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. <br /> I Character of soil to a depth of 3.feet: Sand El-`'Gravel ❑ Sandy Loarr�,& Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 10 New Construction: Yes �T, 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_u� --_____-Distance from foundation----/0----------Material-------------------- -----________ r_._______- <br /> No. of compartments__--_- -- .......size---- depth--------- Capacity------- ------ _--- <br /> i <br /> r <br /> Disposal Field: Distance from nearest wel!__5d-_._._Distance m foundation______/v-__._-.Distance to nearest lot line-----"_._.. <br /> Number of lines_______ '___________ _____Length of each line---------—--------------- of trench-__.____Z�e�-_________ <br /> Type of filter material_ ___ Y _Depth of filter material.....--/2`(____-___Total length_________________f_ _ .__________ <br /> Seepage Pit: Distance to nearest well--------------;7--4-7--Distance from foundation____________.--___.Distance to nearest lot line----------------- <br /> _ <br /> ❑ Number of pits----------=----- =----Lining material------ --------t-------Size: Diameter-----------------------Depth---------------- <br /> Cesspool: Distance-from nearest well______`__._____Distance from foundation-_________________I F Lining material_--:_-_--________.-__-__________-__. <br /> -- -- _Depth_----------`---------------- -- Liquid Capacity------------•--------------gals. r <br /> ❑ Size: Diameter--------------- --- ----------- -------------------- <br /> Priv Distance from nearest well_______________________----______------ -.----Distance from nearest building_--__________._______________----_______. <br /> Y�. - <br /> - Distance to nearest lotj,ne------ ------------k---- --------------------------I------ --------------------------- ---- ----------------------- - <br /> Remodeling and/or repairing;(describe)-------------------------- =----------------- ..----------•-----•--------------------------•-•-:-------------••------•---------------------•-- <br /> r ___-________--`_________________________________________________________________________________________________________________________________ <br /> f <br /> _________________________-_______.. <br /> e. <br /> ________________ ___________ ___ __ _______________.___ __i_;______________.__________ .______..__.__________...______._...__________.-_______.-______.___________________...__________-._____.__. <br /> I here_ by cert ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed);/--? --------I=---------------------------------------------------------------(Owner <br /> --------(Owner and/or Co <br /> "" -----•---------------------- (Title) ------------- <br /> (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). <br /> k <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY y <br /> r�� <br /> --- ----- DATEV11 WED BY ----------------------- DATE-------------� ------- <br /> RE - - -----BUILDING PERMIT ISSUED----"•---------------- ---- ------------------------------------------------------------ DATE ---•---- <br /> Alterationsand/or recommendations:--;; ------------------------------------------------------------------------------ -------------------------: •-------------------•-------- <br /> ------------------ <br /> ----------------------- ---------------------- <br /> ------- ••------------- ------------n. <br /> ------- -_--•----•---- --le----------------------------- ----------------------------------------------•----------------- ----------------------------------------------- <br /> ---------------- <br /> ' <br /> �4e0 --------- <br /> ------------ Date.---- -/� -• -�--�-- --- �'-�•--------- - <br /> FINAL INSPECTION BY::_-.-_ <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 /> re n 'AA RnZ;'wA W-2100 <br />