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...c- �-.�*. <^�-oma` <br /> APPLICATION FOR SANITATION PERMIT Permit No. ;zf A.4. <br /> (Complete in Duplicate) of I S <br /> Date Issued <br /> V Y <br /> Application 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 LOCATIOK.54 ----- -------- <br /> .f--. -.• c± 4�'. - ? - /_. . :�_�._ Q Q - <br /> Ray <br /> Owners Name l� Q . +f -QQ� Phone---- <br /> -------------------------------- <br /> Address-------------------------------------------- <br /> --------------------------------Address-------------------------------------------- ' -sem• . - <br /> 4 Contractor's Name y Jl 'l � ---------------- Phone-- � + zy�----- <br /> Installation will serve: Residence Apartment House F1 Commercial Trailer Court 0 Motel 0 Other <br /> Number of living units: -_/-. Number of bedrooms -_>"Number of baths ---L- Lot size ... ------------------­- <br /> Water <br /> -----------------Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table */oft. <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 A New Construction: Yes ( No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> CfSe tic Tank: Distance from nearest welL� ____Distance from foundation/ -'-� <br /> ----.Material--/ ___�-'--=.' .'I--'-d---------- <br /> No. <br /> ---- <br /> No. of compartments-----�_--__- '_ ------ <br /> -__-Liquid depth ? ________Capacity -, <br /> Disposal Field: Distance from nearest well--5 __Dista* -3f" <br /> from ffoou-nndation__/__�D_�-__..Distance to nearest lot line__:_..�' <br /> - ' -.Width of trench .? +M-`_--------- <br /> Number of lines______._./_,.,j,--A,;-----Length. of each line_____f__t"�._�.Type of filter materiall2.---�K_,_Depth of filter material-1-8----___-__Total length.....AVa--.____-•__ --_---_._ <br /> Seepage Pit: Distance to nearest well------------------_____Distance from foundation--------------------Distance to nearest lot line <br /> ❑ Number of pits-------_-------------Lining material__-_ _______________Size: Diameter---_--_--------------Depth--------------------------------- <br /> Cesspool: <br /> ____-_-_. __----____--____-_Cesspool: Distance from nearest well-:._______________Distance from foundation--------------------Lining material_:------------------------------------ <br /> E71 <br /> .-______--- _-_______-----.---.❑ Size: Diameter--------------------------------------Depth----- ----- ------------•--- --------- --------Liquid Capacity---------------------------gal <br /> Privy: Distance from nearest well_________ ________ .___-__-_--.-_ -____ ___Distance from nearest building------------------------------------------ <br /> El <br /> ____-_---- _-_--__.__________ _--___-.-❑ Distance to nearest lot line------- - ----- --------.............------------------------------------•---•---------------------------- <br /> Its Remodeling and/or repairing (describe):------------------------------_------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------- <br /> 1 hereby certify that I ve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, a ules and' regula+ions f the an aquin Local Health District. <br /> t .- --- <br /> (Signed) ! = Y r Contractor) <br /> G3�Mrrwa�d f e <br /> BY•---- ---- -------------•---------------•-- ---------------------•--------------•-----------------•-----------------------.(Title)--- - �" '-----��--2 �-----------------•----- <br /> (Plot plan, s mg size of lot, locat• n o, system in relation to wells, buildings, etc., can be Vaced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_-_ ..-___...___ __. •- DATE. <br /> REVIEWED BY-------_--- --_--- -- ---- ----•----------------- ----------------- DATE <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------------------------- -•-•-------------- DATE- ------_� --- ---- -------- --------- <br /> Alterations and/or recommendations:. ------- ----------------------- --------------------------------------................----------......................................... <br /> --------------------------- ---•----- <br /> ---------------------------------------------------------------___----------------------------------------•-----------------------•............................... <br /> ------------------------------------------------------------ -- - -- <br /> ---- ------------------------- -- -------------------- ---------------------------------------..................................... <br /> FINAL INSPECTION BY:---- ........------ ------ - ---- --- --------- Date----------- - --------- ------ <br /> SAN <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 /> ES-9-2M 8-51 Revised W-2100 <br />