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Cb-g� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 9 _ <br /> Date Issued --- <br /> Applic&ion is herby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> ( ,his application is made in compliance with County Ordinance No. 549. described. <br /> l / 7 <br /> "JOB ADDRESS AND LO N 'l��_._ rQ-4 _. ------ �------- --.. T.�. y` <br /> -- <br /> Owner's t -- ................................ <br /> (� rf <br /> Address-- ---•- j--- <br /> Contractor's <br /> -+} G�-+'t ------b d I <br /> - --- !e--------------•----------- <br /> Contractor's Name_-' �. •�. _ <br /> _ --------- Phon <br /> Installation. will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel r] Other <br /> Number of living units: -------- Number of bedrooms ---------Number-of baths -_.----- Lot size _ --- — <br /> -------- ------------------- -- <br /> Water Supply: Public system E] Community s - <br /> ystem ❑ Private Depth to.Water Tablet `__ ft. <br /> Character of soil to a depth of 3 feet: Sand [_] Gravel ❑ Sandy Loam Clay Loam [❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No M New Construction: Yes [9'�'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> V <br /> Septic Tank: Distance from nearest well 9-Q------Distan e f�rom_fj3un �afion---10_,._------.M ferial___ hy_----_ "�-l? <br /> Cam p �( __ T_ . '. s , <br /> No. of tom artments_.__..` ----- --------Size-�$ --___ -- Liquid depth--------- <br /> ---- Capacity-- -Y <br /> Disposal Field: Distance from nearest well-_--__.__-.___._Distance from foundation------------- ------Distance to nearest lot line_______ <br /> ❑ Number of lines------------------------------ ----Length of each line------------------------•-----Width of trench-.-----•---------------- -- <br /> ---- <br /> Type of filter material---------------------- Depth of filter material-_.--------------------Total length_-_._---_.-.---_--..---.-__-- <br /> See�pa,/ge �it: Distance to nearest well__- --- -__-_-Distance from foundation____ 4ance to<ne o ine--___'__ ____R Number of pits._-- _..-_ g Size: Diameter.__ e� f <br /> Linin matenaL_�^-x!-11 .. tFl �GCesspool: Distance from nearest well-----------------Distance from foundation.-.._.-_- -.----..Lining mate -------------------Size: Diameter-------- ------- Depth uid Ca acit <br /> - r. - <br /> L�q_, �P ------------ -- -----------gals. <br /> _.._ M-- � -- .��... .� <br /> ---privy: Distance from nearest well..-------} ---__ istanc fr earest building. <br /> ---- - -- ----•---------------- <br /> ❑ Distance to nearest lot line..._.--_---___. T <br /> - -------- -- ------ ----'------- 1 <br /> Remodeling nd/o pairing (describ :_ { ------- ---------------- <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 /> ordinance to laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed ..... -•-------•--- <br /> j ` {Ow er and/or Contractor) <br /> By: ... �!�l0.' ±fit- - Title <br /> - -- -------------------------- <br /> -- ---- - ----------- ----- <br /> ( ) 2 <br /> {Plot plan, showing size o t, location of system in relation to wells,.buildings„etc., can be placed on reverse sid <br /> - - -VP <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------------ ------- <br /> ------------------------ <br /> REVIEWEDDATE--------- <br /> _& <br /> A <br /> BY ----------------------------------- -- -- -- �� iss <br /> BUILDING -PERMIT ISSUED------------ '� DATE---------- -------- ------------------•-- ---- <br /> ---------------- --- ------ ---------------------•--------- ------------- DATE <br /> r <br /> Alterations and/or recommendations:-------_----------._ ._ <br /> -------••--- ---------�-�^— -------- <br /> t4-40 . _t ------------------------------------- <br /> 7J �- . _ <br /> ------------------------ ----------------- --- - <br /> T <br /> -----------=--------- ------ - <br /> FINAL INSPECTION BY:. --- ------------ Date r/_. ------- <br /> SAN 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 /> e5--9 145445 ATwaoa <br />