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APPLICATION FOR SANITATION PERMIT Permit No. 1_ <br /> ----------- - <br /> (Complete in Duplicate) <br /> Date Issued ._y� _ <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 withCounty Ordinance o. 549. <br /> `T / <br /> JOB ADDRESS AND L CATION--__----- ---- =-- - --------(� ,� <br /> Owner's Namey � / - ----------- <br /> - Phone-41 .�i <br /> --------------- 2 � <br /> I Address. --- 2` -- - <br /> ------------------------------------------------------------------------------ ---------------•--------------- <br /> Contractor's Name__________--. ;:62 <br /> ------------------ ------------------------------I---------------------------- ------ Phonft_. <br />' Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __,-_ Number of bedrooms �__. Number of baths __ __ Lot size -Z-ft. <br /> Za Supply: Public system ❑ community system ElPrivate Depth to Water Table <br /> rq or of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> evi s Application Made: Yes R NO ❑ New Construction: Yes No FHA VA <br /> ( -. ❑ � / . Yes ❑ No <br /> 1� OF INSTALLATION AND SPECIFICATIONS: <br /> (No sap+ic tank or'cesspool permitted if public sgerer is available within 200 feet.) <br /> ptic ank: Distance from nearest well-- <br /> P <br /> ell_ -- Distance fpom foundatrbn___ �_-____._.Mater <br /> f <br /> No. of compartments______- <br /> I _--Liquid de�h_-___- _ _ Capacity_ <br /> �►� - <br /> pas Field: Distance from nearest ell.----------------Distance from foundation--A--- <br /> - Distance to nearest lot ine-___ . ------- <br /> Number of lines....... Length of each line_______ r-___.1Nidth of trench <br /> Type of filter material____ __ <br /> Yp th of filter material----.__-- (Total lengp-_.___- <br /> 1 --. ------- <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation-------------- Distance to nearest lot line-______.-_____--_ A <br /> ❑ Number of pits------------------- Lining material-----------------------Size: Diameter--------•---------------Depth--------------------------------- �. <br /> Cesspool: Distance from neaFrest well----------_---___Distance from foundation--- l-_---------------.Lining materia!_____.___--___.____-_._-__-_.______ <br /> t <br /> Priv Size: Diameter-------------------------------------Depth--------------------------f>--/--------- -- ------Liquid Capacity----�-------------------gals. Q <br /> y: Distance from nearest well____---_______________________---------___ _ -Distance from nearesf building---------------------- <br /> ❑ Distance to nearest lof line ------ <br /> ----------------------- <br /> ----------------•---- -- ------ <br /> Remodeling and/or repairing (describe):_:_-__._r_-------------- _ <br /> - <br /> --••---------------------------------- <br /> r <br /> y <br /> . ______________________________________________________ y - <br /> Y y prepared this application and that the work will be done in accord------ ------------------ ----------------------------------- - ------ <br /> - - - - ------------------------------- <br /> crab certify that Ihave - -------------- ---------- ----------- ---------•--- <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, dance with San Joaquin County <br /> (Signed)----- ___- - <br /> er <br /> /or Contractor) <br /> BY:--•----------------------- i. (Title)------------------------------------------ <br /> (Plot plan, showing size of lot, locatiorr-of system irn-relation to wells, building's, etc., can be placed on reverse side). f <br /> FOR DEPARTMENT USE ONLY =� <br /> APPLICATION ACCEPTED BY------ <br /> --------- ----- -- - - -----7—, <br /> DATE------ <br /> REVIEWED BY c -- -------------------- <br /> --- DATE _ <br /> BUILDING PERMIT ISSUED_______________ ____ . <br /> - ----- ------------------------------- ------- DATE-- =- <br /> -------------------------- <br /> terations and/or recommendations:__'-___ <br /> --------------------------------------------- -- -- ---- <br /> !1 - -- /�-- - ----• -----------•-----•--------•-----------•----•-------------- <br /> - r�L <br /> ------------------ ------------ <br /> --------------------------------- <br /> �_�? <br /> - - ----••----- •------------------------------ _ <br /> C`-Cp ----------7--------------- <br /> ­7 <br /> --------- --------------- <br /> C a7- <br /> ---- -- --- - - <br /> t�1_- - 7 <br /> FINAL lNSP /ON BY: ---------------- ------------ ----------------------- = Date <br /> --------------------------- <br /> SAN JOAQUIN`LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street `` <br /> r 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-4-2M , Revises 1-57 F.P.Co. r ' <br />