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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> 7 = <br /> Date Issued <br /> F , Av—Z <br /> Appli�a{ion <br /> i 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. Af___Z__4 F A02--Z � <br /> JOB ADDRESS ANq ,9 <br /> _�OCATION--- - --------- -- -(--------------- --- ------------ ----—---------- <br /> ---- ------ - <br /> tJ <br /> A j . -_ ,f ------------------ <br /> Owner's Name------�Y_1_611 ........ ... ------------------- -------------------------- Phone------------ <br /> - -------------/--------I---------- <br /> Address---_----------------- 11 ----------=------------------ --------- --------------------------------------------------------- <br /> Contractor's Name------------------ ---------- ------ ---------------------------------------------------------------- Phone- <br /> Al <br /> Installation will serve: Residence Apartment House E] Commercial 0 Trailer Court E] Motel F] Other El <br /> Number of living units: ---- Number of bedrooms 1/-. Number of baths/---- Lot size .......7 ,,,f------------------ <br /> Supply: Public system [I Community system El Private 2--6epth to Wafer Table -------- ft, <br /> Character of soil to a depth of 3 feet: Sand GravelE] Sandy Loam [j Clay Loam El Clay [-] Adobe 2-<ardpan E] <br /> Previous Application Made: Yes E] No New Construction: Yes E] No 019n.,Z7k <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well-7-(-----_Distance from foundation-/---------------M riai-----!��-------------------------------- <br /> No. of compartments--- --------- ----------- Liquid dep.th-_,X . .........Capacity-/ <br /> Disposal Field- Distance from nearest DistanceTrom foun,dafion--,/-19........Distance to nearest lot <br /> Number of lines----- 2j---- Length of each line---jR;Z_4__- Width of french_----- <br /> 0 <br /> Type of filter material--- of filter material-__-Z_Z_ ---Total length-------X.; <br /> -4 <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> n Number of pits----------------------Lining material-----------------------Size: Diameter----------------------.Depth-------------------------------_ I. <br /> Cesspool: <br /> epth---------- ---------------------- <br /> Cesspool- Distance from nearest well-----------------Distance from foundation....................Lining material---.------ ------------------------ <br /> Size: Diameter-------------------------- -- -- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----------------------------------------.-- Distance from nearest building------------ ---------------------------- <br /> ElDistance to nearest lot line ------------ - -- ----------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)---------------- --------- ------------ ------------I--------------------­-------------------------------- -------------------------------- <br /> ---------­­-­--------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- <br /> --------------------------- --------- ------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------- ------------- ------------------------------------------------------------I---------------------------------------------------------r---------------------------------------------------- <br /> I hereby certif that- have prepared fhi pplication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I ws, and rules an regulafo s of the San Joaquin Local Health District. <br /> (Signed)--------------------A---- -- _- -- '---------------------------------- -- -- ---------- ------------------------------------- ------- Co tractor)­�� <br /> By:--------------------I-------*----------------------------------------------- --- ----- - wells, 9------ ----------------(Title)_ <br /> ---------------Fit Ie)_ ------------ <br /> S, <br /> e <br /> (Plot plan, showing size of lot, location of system in re ton to s, buildi s, etc., can be placed on reverse side). <br /> FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..� ----------------- DATE ------ <br /> REVIEWEDBY----------------------------- ------- ---------------------------------------------- DATE-- -------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------qQ__r------------ --------- ----------I-------- <br /> Alterations and/or recommendations:----------------- ------------ --- -- - - ----- ------------------------------------------------------------------------------7-------------------------------- <br /> ----------------------------------------------------------------------------------- - ------- ------------- ----------------------------------------------------------------------------•------------------------------------ <br /> -------------------------------------------------------------------------------------•-----------•--------------------------------------------------------------------------------- -------------------------------------- <br /> ----------------------------------1--------------------------------------------- -------------------------4---------------------------------------------------------------------------------------- ---------- <br /> ----------------------------------------- ------ - ------------------ ---- ........ -- ------------------------------------- ------------- -----------------------------------------:----------------------------------- <br /> Sw <br /> FINAL INSPECTION BY:. --- ----- ------------------------------------------ <br /> Date. .-. --------- ------- <br /> -------------------------------- <br /> SXN 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 /> E..U___9_2M 145446 A7WOCD 12.54 <br />