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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) /d/ <br /> 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 Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.........�7�1 <br /> r - 1✓ f t <br /> --------•-------------------•--- ------------------------------------------------- <br /> Owner's <br /> -------------------------- -•------------------Owner's Name---------A4_iJ __Q-f-'1IV-, <br /> Address --••- <br /> --- ---------- Phone---------------- --------- <br /> "� <br /> I <br /> Contractor's Name---------- --/f 1 ._! S'1__- _.. ., <br /> ---��-`�------------ - -- ---------------• ------------------- ---... Phone--------------------------_-- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑. <br /> Number of living units: ____I__ Number of bedrooms ___'Number of baths __ __ Lot size ___7,_e> F . <br /> Water rSupply: Public system ommunity system ❑ Private ❑ Depth to'Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3 —Htrdpan ❑ <br /> Previous Application Made: Yes E] No [4----Iq_ew Construction: Yes Egi— o F] - <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__,_______________Distance from foundation--------------------Material <br /> -___.____-________. - <br /> ❑ r—)(ii S 10C-No. of compartments--------------------- ----Size---------------------:-------=--Liquid depth:-------- ------- -------Capacity <br /> Field: .. Distance from nearest well--------------- Distance from foundation_ _______..___..._.Distance..to nearest'lot line-------------- <br /> ❑ iY s'5 7Number of lines----------------------------------. Length of each line-------------------_. <br /> ------._.Width of trench------ --------------------------- <br /> ----------- � <br /> Type of filter material-------------- Depth of filter erial------ Total Meng#h----•-------•------------------------- <br /> - i <br /> Seepage P- r Distance to nearest well _-�-'---._-_D•sstanc_ - rom.founda ' n4--r____.Qistance to nearest lot line --�--. <br /> Number of pits----_._:.1_:.____-__Lining material __ _'_ ?L_Siz Diameter___."]'13-�_�__..Depth_____- `s-�-------- <br /> G. <br /> Cesspool: Distance from- nearest well------------- Disfanc fro u tion_________________ Lining material __-___ -------_ <br /> ❑ Size: Diameter.----- ---- ------Depth --------- ------------ -- --Liquid Capacity------_--------------------gals.. <br /> Priv - _- Distaricefrom`nearest 4611 - _ .4:F— <br /> y= ___- ------ ---- -------__ Distance rorn nearest ------------------------------------------ <br /> El <br /> Distance to nearest lot line ------ <br /> Remodeling and/or repairing (describe):------ - ----- --a7!!_ _L_____c_. -------------------------------------------- <br /> ----------------------------------- ----------------------------------------------------------------------------------------------------------••--•---------------••----•---••--••----------•----------------------- <br /> I hereby certify that I have prepared this application and that the work will be done inaccordance with San Joaquin Count <br /> ordinances, State-laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-. J_/A?l R I? 1 6'14 �- �G -r <br /> r - --------- --.( �caner and/or Contractor) <br /> Br•-•- ., -----, -4-- --��J~"------ e)---- <br /> �..,�-�--� .�-- -------------•• -------(Title]-----�---��_ -,a-•`-- ------------ - - <br /> - --------------- <br /> ot plan, showing size of to+, oca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- --- ---------- �------------------------------------------••----------- DATE------- <br /> ~�---------------- ---•-•--------- .. <br /> ------------- <br /> REVIEWED BY------------------------- - -- ------------------- �°"�-- � DATE-----------Q----- ---------.-----------------•---------- <br /> BUILDING PERMIT ISSUED = -------------- -- ---- --------------------------------------- DATE a <br /> - - <br /> Alterations and/or recommendations:--------- -----------,-------------------------- <br /> r -- <br /> --•------- --- ..r.._r <br /> •----------------- ----------- '�: <br /> rrrr _ <br /> FINAL INSPECTION BY:. = Date--.----/. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stroet 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9 ,g5g46 gTWODO <br />