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APPLICATION FOR SANITATION PERMIT Permit.No, rt_ _:.�f <br /> (Complete in Duplicate) <br /> Applic&ion is hereby made to the San Joaquin Local Health District f Date Issued ____!(s <br /> This application is made in compliance with County Ordinance No. 549r a permit to construct and install the work herein described. <br /> JOB ADDRESS AND LOCATION-------//7-lf �.2 p� <br /> ----- <br /> ---------------�'-�---- -------------------------Owner s Name.- <br /> -•- -------���-� _-GC'C��� : <br /> ----• <br /> - ------ ----- � --- -------------- --- ------- ------- -- <br /> Address_._--'44,----�!"l�/_��trC.� " " -- ---.."..---•---- <br /> - <br /> -------------------------------------------------------------------•- ----------------- --------- <br /> -------------- <br /> Contractor's Name._"__""•_•?`-J' Q� <br /> = �-fl <br /> --------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial Phone. 3. •____ <br /> ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living unifs: _`-"" Number of bedrooms _ _. Number�,of laths .-1"_ tot size ------ ' � <br /> Wafer Supply: Publics stem I, ---------------------------- <br /> Character <br /> --- <br /> Y �~ Communif s stem ""----""" """--- -"'-- <br /> Y Y ❑ Private ❑ ,Depth to Water Table SG ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam E] Clay F1 Adobe <br /> s®` <br /> Previous Application Made: Yes ❑ No'm` New Construction: Yes E] NoHardpan ❑ <br /> 's' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> (No septic tank or cesspool permitted if public sewer is available within 2004eet.) <br /> t .. <br /> Septic Tank: Disfance from nearest well"?�4 < <br /> Distance from foundation_1 __•_--:-_-MateriaL_ ."_ c., <br /> IJ o. of compartments_:-____._ _. Size J _�( G <br /> `� - ------Liquid depfh_`� <br /> ----- -- Capacity---. <br /> isposal Field: Distance from nearest well",-----_------_-Disfance from foundafion_n---_..- --'.Distance to nearest lot line--""-_"".."-."".. <br /> ❑ Number of'lines------------------j,r ------" -Length of each line-.-----:___--I <br /> v Y Width of trench <br /> Type of filter materi#I"""''*-_-=--Depth.,of'filter mafenel� ""� --V`TofaI, Iength_-_.-------------------------------------- <br /> d <br /> "-._"-------------"-__"_____ __ <br /> Seepage Pit: Distance to nearest_weILs ---Disfancef, f undation /._�_ <br /> Number of pits__"--: ---------Li,i.ng material-_{ Distance to nearest lot fine-""-------------- <br /> ----Size: Diameter- � Depth �----------------- <br /> Distance <br /> Cesspool: from nea est'well_- •�_:__'•Disfanc9 from fou ation._--_._---_- !"" <br /> ! fi.� �r ---- Lining material- --- ------•---•- <br /> ❑ Size: Diameter - --------- <br /> ---- De th ----------- - <br /> 1 p . —t I------------------------- 1--Liquid Capacity_-------------------------gals. <br /> Privy; Distance from nearest well----- _D <br /> ---------- I <br /> El F_ _ .istance from nearest building Distance to nearest lot line...-:.-_ T `�-�" g <br /> ------------------- <br /> • ------------------ i <br /> ------------------ <br /> emodelingand/or repairing (describe):z----- -----------------------------------------------------I------------------------ ------•-•--•---------------------•-----••-------•----•----------- <br /> ---------­--------_--------------------------------------- i <br /> --------- <br /> I <br /> --- ----•--------------------- -------------------- ---------------------•--------•------------;-- ----------•-------------- --------•---- <br /> ' [ i <br /> ----•-----------------•-----------------t----------------------------------------------------------- <br /> I hereby certify that I have prepared this application and thaf'fhe work will be done in accordance with San Joaquin County <br /> ordinances, Sf'ate laws, and rule and regulations .of the San Joaquin'Local Health;Disfrict.' <br /> (Signed)_-- <br /> ------ ----------------------- ----- �------------------------------------ ------ - (Owner and/or Contractor) <br /> (Plot plan, showing size of lot, location of system in rel" --. io wells, buildings,e4c can bele'laced o <br /> ------------ <br /> -- —R P reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- <br /> _--"-__. <br /> = - DATE <br /> REVIEWI=D BY------- - -------------------------------•---- <br /> ----------------------------- --- - ---- <br /> DATE- �t -----------BUILDING PERMIT ISSUED ------------------------------------------------ <br /> Alterations and/or ------ <br /> DATE____-- <br /> -- --- -------------------------------------- <br /> --•----------------- <br /> --------•- <br /> --------------------------------------- ----- `. <br /> . i . <br /> 't� Wit.---•-------••----- <br /> ------------- <br /> -------------------- <br /> i <br /> FINAL INSPECTION BY:..____-"__.__- _ <br /> Date------------- <br /> AN <br /> JOA - <br /> LOCAL HEALTH DISTRICT <br /> 130 South American $treat ' 300 West Oak Street <br /> 132 Sycamore Street 814 North "C Street <br /> Stockton, California Lodi, California <br /> Manteca, California Tracy, California <br /> E`-r'9—ZM <br /> 145446 ntw000 a2-s4 <br />