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APPLICATION -7 -3 <br /> FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica4ion 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 /> j, <br /> JOB ADDRESS AND LOCATION... 1 1- �_ tr, <br /> - ----------- ---- -------------------------------------------------------------------------- <br /> - ----------- -------------------­-- ---- Phone----- ---------- <br /> Owner's Name----- <br /> --------------- <br /> Address-----•--------- -:j------- <br /> ------ --------------- ----------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name-----------tL, —-------------------------- --------------------------------------------------------------- Phone <br /> Installation will serve: Residence W Apartment House D Commercial [] Trailer Court E] Motel [I Other E] <br /> Number of living units. <br /> "Nu b.r of bedrooms ---),--Number of baths _t___-- Lot size <br /> Water Supply: Public system Community system [I Private E] Depth to Water Table -------- ff. <br /> Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam E] Clay.Loam E] Clay E] Adob6Z, Hardpan ] <br /> Previous Application Made: Yes D No K New Construction: Yes No F-1 <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 <br /> well-ArD-------Distance from foundation----J__0---------Material__ _ :'-.4_�, : _------------- <br /> No. of comparfm • <br /> ents.- ------------- Liquid dep�h_-----U----------------Capacity---- -- <br /> Disosal 'Field: Distance from nearest well-,-U <br /> O-___-_Distance from foundation.__I_C)----------Distance to nearest lot li.ne___� <br /> -------------- Len 1, of eaFhh line--- <br /> Number of lines_____- f / ^� ---------------Width of french...... <br /> Type of filter material", "'.:,D e, -f f�-f aria!-------IT r--------Total. length------ <br /> b� , bk-mai <br /> Seepage Pit: Distance to nearest well------------------- <br /> ---Distance from foundation_.__.________-___.Distance to nearest lot line-_____.________- I <br /> ❑ Number of pits----------------------Lining material---------------- Q <br /> . ize: Diameter-------------_--------Depth-_------------------------------- <br /> Cesspool: <br /> epth-------------------------------- <br /> Cesspool: Distance from nearest well------------- ---Distance from foundation--------------------Lining material-__________________._________ <br /> ---------------------------------- <br /> El Size: Diameter.--------------------- ---------------Depth-----------------------------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well----------------------------------._r-------------Distance from nearest building----------------------------------------- <br /> 0 Distance to nearest lot iine------------------------------------------------------- <br /> Remodeli and/or repairing (describ <br /> --------------------------------------------------------------------------- <br /> a --------- ---------------------------------------------- <br /> a 0/o <br /> ------------ ---------------- --------------- 4 - <br /> ----------------------------- <br /> ---------- -- -----=­- -------------------- <br /> - - 14' ' .. <br /> -------------- ---------- <br /> ------------------------- <br /> _­ <br /> 40ae——------------------------------------------------------- <br /> ------X - ------- <br /> ----------- ____------------------ --------------------------------------------------- <br /> I hereby certify that I have pre tired this applicatititr and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ----------------------------------------I---------------------------------- <br /> (Signed)-,---- ......r-I/-- - ----- -------(Owner and/or Contracto <br /> 0 <br /> By:--------------------------:--------------------------- <br /> ------------------------------------------------------------------------------(Tit le}------------------ ------------------- ------ - <br /> ' (Plot plan, showing size of lot, location 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_. ------------............ --------------------------------------------- <br /> -------------------------------------------------- ----------------------------------- <br /> ------------ DATE...... <br /> BUILDING PERMIT ISSUED- <br /> DATE <br /> Alterations and/or recommendations: -------------------_-------------------------- ----------------- <br /> ------ N-------------------------- <br /> --------------- ------------------------------------------------------------------------ --------- ------------- <br /> -------------------------------------------------------------------- --------------------- --- --------------- --------------------------------------------- ------------- <br /> ------------ --------------------------- <br /> ---------------------------------------------------------- --------- ------------ - ---------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- -------------------------------- <br /> --------------------------- ------------------------- ----------- - - ----------------------- --------------------------- ------- --------------- -------------------------I---------------------------------- <br /> FINAL INSPECTION BY..----- <br /> ------ ------------------------------- Date---- ----------- <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 /> 145446 A7WOUD 12.54 <br />