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APPLICATION FOR SANITATION PERMIT Permit No. - -3___ <br /> (Complete in Duplicate) <br /> Date Issued ---.3_____T•--,--- <br /> L 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 Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION___-. ----- --------------•---------------- <br /> Owner's Name---- <br /> -• -- ----•--- .. --- <br /> ----------•-------•--- - ----------------­ Ahone------ -------------•-----••---•-•- <br /> fr Address <br /> Contractor's Name______..._. , <br /> -`'-------•-- -- _ '-------------------------- <br /> Phone. <br /> Installation will serve: Residence <br /> R4- Apartment House ❑ Commercial El Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units: --/-- Number of bedrooms _ Number of baths ---f Lot size <br /> X ---------------------------- <br /> Water Supply: Public system &Cornmunit system Private Depth to Water Table <br /> Y Y ❑ .❑ p sv_ ft.. <br /> Character of soil to a depth of 3 feet:' Sand. Gravel <br /> p ❑ ❑.-�Sa ndy`Loam^❑ Clay.Loam Clay ❑ Adobe❑ Hardpan_ ❑ <br /> Previous Application Made: Yes ❑ Nc P-"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 /> ep T k: Distance from nearest i <br /> / :Distance from foundation-- -- ------------Material------------------------- <br /> �c No. of compartments............... -------Size-------------------------------Liquid depth.----- Capacity <br /> ispos Field: Distance from nearest well-----------_-----Distance from,foundation--------------------Distance to nearest lot line---..___--____... <br /> >� Number of lines------------ ---- ------Length of each line----------------------- <br /> -------Width oftrench------------------------------- f <br /> ype 6r filter material-------------------------Depth of filter material-._.______ Total length----------------------------------- { <br /> --•- <br /> Seepage Pit: Distance to nearest welt_. . <br /> t "_ ___Distance from found tion___ __s� ' Distance to nearest lot line.____.______. <br /> Number of pits-------,�-'--------Lining materia!_-d4jiQ ze: Diameter--- e�--.----Depth------ - <br /> Cesspool: Distance from nearest well_______________ Distance foundation-____---___..__--__lining material__-___-------------- ' <br /> ❑ Size: Diameter-------- ------"---------------------Depth------------------------------ "----- <br /> Liquid Capacity--- ---------------- <br /> -------------------------gals. <br /> Privy: Disfance from neare_st well..................... '+ m <br /> _-_--_-_._._-__� Distance from Inearest building______________________________ <br /> ❑ Distance to nearest lot line________________ 1 <br /> Remodeling and/or repairing (descrii�e):_____„ <br /> �c <br /> ----- _..-----•`• �- -------- <br /> - ----- ------------- <br /> r <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 laws, and rules and regulations of the San Joa uin'Local Health District. <br /> Si ned '+` t <br /> ( 9 } �E� l = <br /> - -���-------------`-----_-_____".__----Owner and/or Contractor <br /> $Y: " m, < ---------(Title)----- <br /> (Plot plan, showing sof lot, location of system in relation to wells, buildings, etc., can be placed on rever side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__________ -------------- _- <br /> -- - --�-"- �-�•-------------- •------------------------ -- DATE-------�.----------•---•---••------- <br /> EVIEWED BY------ -----------•---- <br /> t BATE �__` <br /> BiJILDING PERMIT ISSUED --------------------------- ---- ---- - �- - ----- ----------- - •----------- <br /> Alterations d or r commendations:/ ----- --- ------------- -•-------•--- -•-----•--- --- ------- <br /> ----------------------------------- <br /> T ____ <br /> _____________________________ <br /> FINAL INSPECTION BY:....... J -� <br /> -- -� - -------------------------------- Date..... <br /> �-------•-------- - - --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak $free+- 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> rs-9-2M 145846 ATWg4D 12-Sa r <br />