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1INT <br /> APPLICATION FOR SANITATION PERMIT Permit 'No. <br /> (Complete in Duplicate) Date Issued <br /> Applica+ion is hereby made to the San Joaquin Local Health D- r'icf for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinanc o. 549, <br /> JOB ADDRESS AND LOCATPN..____- ____ ---------- --- --------------------- - ----------------- <br /> Owner's Name------_-- ------ ---- K ---------- -- -- ----- <br /> 6 ---------- -I------------------------------------- Phone----- <br /> kAddres - ---- - <br /> - ------------ ------------------­L----------------------- <br /> i-------------------------------------------I-----------­----------- <br /> !Co'ntractor's Name________________ --- ------------------------------------------------------------ Phone--.3, <br /> Installation,will-serve: Residence Apartment House ❑ Commercial [:] Trailer Court ❑ Motel ❑ 'Other ❑ <br /> o/ <br /> Number of livi�_g_unK Numberofbedrooms-- of baths /---- Lott size <br /> 4 ----------- ------------ <br /> Wafer Supply: Public *system Community system ❑[I Private ❑Li <br /> .tiJ Depth to Water Tabl� ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam L) Clay Lci-am E] Clay El Adobe Hardpan E] <br /> Previous Application'Made: Yes n NO New Construction: Ye <br /> No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> *12 (No,septic tank'or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank--3 Distance from nearest w61-,,7-L-pr'-__Disfa e fr m foundation-- -------Mat <br /> ___Capacj y---- --- <br /> t No. of compartmenfsx,--f—------- ----------Size-:? --Liquid clepth__ <br /> x N ---- ------ <br /> Disfrom nearest well___.--._.__.___Distance from foundation----- __Distance to nearest lot line-!_____..____.._. <br /> p s+ance _ <br /> + y Number o f,lines-----------------------------------Length of each line-s _------- WidW- of french <br /> Type of filter material-------------------- ----Depth of filer material-----------.-.------..Total 'length------------------- --------------- <br /> -we A--%, `\ -1---------------------- <br /> Seepc it: Distance 10 nearest jell------)1*-,_A,_Distance from foundation /!P---------Dist <br /> ./ L .4 grice to nearest lot line--8�--------- C� <br /> N,'mber of- ------ ---- I ... j ! <br /> I - r --------- <br /> �7ts_ i ing maiferial--a-.1�' --------Size: Diamete ------ Depth <br /> - 1-Lin <br /> v�7 ....... ......... <br /> Cesspool: Distance.,1from.. nearest well--------------.--Distance from foundation.- ---------Lining material___ __- --_.__ ___- -_____ <br /> e: Diamete'r\ <br /> ­�------------------------------:----Depth----------------- -------- ----- --- -----Liquid,Capacity...................... 0als. <br /> Privy: Distance from nearest well__________________________________.._______- <br /> ----Distance from nearest building------------------------------ ---------- <br /> El Distance to nearest'lof lire------------ <br /> --------- --------- <br /> ----------------41 ------------ <br /> Remodeling d <br /> a�-- -------------- -- <br /> r r6pairing (describe):------ <br /> ------- - - - --­-------- -- ------------- ---------------------------- 2------I---------------- <br /> ---- ------------ --------------------- <br /> ----------------------- ---------------------------------- ------------ <br /> ------------- ----- ----------•------"--- ---------- I t <br /> ----------------------- --------- --------------------------- --------- <br /> I ereby certify that I have prepared this applicaifion and that the work will be done in accordance with San Joaquin County <br /> ordinances, SYa"N laws; a, 7 r !as and regulations 0-f the' San Joaquin Local Health District. <br /> (Signed)_ ­- <br /> ------ ----7-------------------------------------- ---------- <br /> Sy:----------------_ <br /> ------ --- ----(Owner-and/or Contractor) <br /> �71----- ------ --------------------By:----------------_ ---- --------------------------------------------- <br /> � Tale <br /> -------------------------------------------- <br /> (Plot plan, <br /> ordinances, <br /> si moflotjocation of system in relafion to wells', buildings, etc., can be/ aced n reverse side). <br /> FOR DEPARTMENT USE ONLY i <br /> N------------ --------- -- ---------------------------- --- DATE__.-�! <br /> APPLICATION ACCEPTED BY -- --------------------------------------------------i--- DATE <br /> BY--------------I - .... -------------- --------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------- - := ZZ---------------------------**---------------*------ <br /> Alterations and/or recommendations:.---- - -------------- - ---------------------------------------­ DATE---------- ------------------------ ----------------------- <br /> --- ----------------------------------------------------------------------------- <br /> ------------------------------------------- ---------------------------- --------- <br /> ---------------------------------------------- ----------••--------------- --------------- <br /> --------------------- --------- -------------------------------------------­-------- <br /> ------------- -------------------------------------------------------------------------- ------------------------------------------------------------------------------I------------------I,- t - i <br /> -------------I---­------------- <br /> ------------------------ <br /> --------------------------------- ---------------------------------------- --------------------------------------------------------I--------_------------------------------------------------------- <br /> ---------------------------------------- - -------------------------- -------------- ------- ------------_------------------------- ------- ------------------- -------------------------------------------------------- <br /> FINAL INSPECTION <br /> Date.......6 <br /> --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Sfreot 014 North "C" Street <br /> Stockton, California Lodi, California k <br /> Manteca, California Tracy, California <br /> Es�_9_zm 145446 A7WQCD <br /> 12-54 <br />