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Permit No. __'S--�_-.- I <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued <br /> Applica+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 Ordinan e No. 549. <br /> JOB ADDRESS AND LOCATION--------------- ---JI��---------- -DA-- ----- <br /> ----- <br /> Owner's Name----------------------------- <br /> eY lS `^ - ---=----- -------- Phone <br /> Address---------------------------------­-,------------------ <br /> Contractor's Name---------------- '�_ ---- -----------------•------------------ Phone----------------------------------- <br /> �. <br /> " <br /> Installation will serve: Residence F1 Apartment House ❑ Commercial� Trailer Court E3Motel [3Other-� <br /> Number of living units: -------- Number of bedrooms -------- Number of baths _ ;? Lot size ------5- _ -=-----^---- <br /> Water Supply: Public system x Community system ❑ Private ❑ Depth to Water Table ---V_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑° Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobejo Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ] New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: /) <br /> (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic 1.Tank: Distance from nearest well___-- D_'---Distance from foundation-----/C?______-_.Material-___._____ U.- --- <br /> No. of compartments--- ----2--------I- Size---5,Z_j----X,3-------Liquid depAh--------- c'�� Capacity - rJ <br /> fl� Distance from foundation____._-----Distance to nearest lot line---- <br /> - <br /> [� <br /> Disposal Field: Distance from nearest well:_ "= :; ` <br /> Number of lines------------- - - - Length of each line___2 ----s------- Width of trench-_____ _uh_---------------- <br /> -f- <br /> --- <br /> Typeof filter material-----� r' Depth of filter material-------- .______.Total length___________Z�_ __________________ <br /> YP , <br /> Seepage Pit: Distance to nearest well_________________ Distance from foundation_..----------._-__.Distance to nearest lot line__-______----____ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------- -----------Depth------------- ------------------- <br /> Cesspool: Distance from nearest well________-____r-Distance from foundation-------------__---- Lining material----------------------------- __-_-_. <br /> ❑ Size: Diameter--------------------- -----Depth-------------- ------------ --- ------Liquid Capacity--------------------------- <br /> Privy: Distance from nearest well------__-._------------------------------------Distance from nearest building----------------------------------------- <br /> ❑ Distance to nearest lot line-- ------ ---------------------- - ------- ---------------------------------------------------------------- <br /> Remodeling and/or repairing (describe);------------------------------ --•-------------------------------------------- ------------------------------------•------------------ <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Owner and/or Contractor) <br /> (Signed)---Ashow <br /> ------------ - ------------------ ------- ------ <br /> BYr ---------------(Title)---------------------------------------------------•------------ <br /> ---------- ------ -------- ------------------------ <br /> (Plot plan �g size of ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---•-------------- --------------------------- - - -------------------------------- DATE----------- a Jr- �"`r(r�----- <br /> REVIEWED BY--------------------------------------------- <br /> DATE <br /> ------- ---------------- <br /> BUILDING PERMIT ISSUED........---------------------------------- ---------- DATE <br /> Alterations and/or recommendations------------------- ---- ---------------_.--------------------•-------------------------------- <br /> - - -- --------------- <br /> � 6Date. <br /> - --------------- <br /> FINAL`INSPECTION -- ------------------------------------------------ <br /> SAN <br /> ----- <br /> SAN <br /> 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 /> cc a a,i - D-;-4 4 W.1Inn1 <br />