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APPLICATION FOR SANITATION PERMIT Permit No. .....l.t'../.......3 <br /> lu <br /> (Com Duplicate <br /> Pete in DP ) Date Issued ..... .3. <br /> This Permit Expires 1 Year From Date Issued 00.5— 1&0—f° <br /> Y_3 3 ✓ �-et A, Q.�t <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 -ounty Ordinance No. 549. <br /> . __ ' y_�I _ . .... <br /> JOB ADDRESS ANPLOCATIION 9 , - <br /> Owners Name._. ,�.7...... .{f".�"�. . -- ........................................--............------ -.....--------......---... Phone.---... <br /> �/ <br /> Address------- p - q --------------............. - -/ ---- - - <br /> Contractor's Name............................ <br /> --......--•'- '---`�' ...............-----------. one� <br /> ._ Phk/.r <br /> Installation will serve: Residence ❑ Apartment House ElCommercial ElTrailer Court E] Motel ❑ Other [✓f <br /> I athsc �ln of size .� <br /> Number of living units: __._--- Number of bedrooms -- ----- Number of b .. .............. ' "' <br /> Water Supply: Public system ❑ Community system E] private �epth to Water Table2o ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan E�— <br /> Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No 2�_P'HA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ <br /> `La�ti k: Distance from nearest well-----------...__Distance from foundation.-----------.__.---Material-...................._..__.__..____.._...- <br /> No. of compartments... Size-----------------------------Liquid depth-..........----------..Capacity..... <br /> -- <br /> + , S'r <br /> Disposal Fi d: Distance from nearest well- D...:.....Distance from found t' n_._ .Q-.--------Distance to nearest lot line................. <br /> [G]� <br /> Number of lines.................... ... . Length of each line__., ._.:Q.-.---ry-----Width of trench..... `�!_._....__........... <br /> Type of filter material..._•S!.� :Depth of filter material..... ,.------..Total length.........._ 0..........^.I....... <br /> i r <br /> SeepPit: Distance to nearest wall_/GG.,..,-----Distance frsm foundation_._`P_.....__..Dista?n i� to nearest lot line__.J.......... <br /> 117 Number of its...... ...............Linin material... pC. ' Size: Diameter.......1A3.........Depth...oiS-o................... <br /> Cesspool: Distance from nearest well...............--Distance from foundation....................Lining materiel....... ...... <br /> ❑ Size: Diameter......................................Depth__..---------_-------­-------.I--------------Liquid Capacity------_----------------gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building........................................`\ <br /> ❑ Distance to nearest lot line-----------------------------------------------------------------------'-------------___-------.......... <br /> Remodelingand/or repairing (describe)-.................................-..........................................................-............................................................ <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 , laws, and rules and regulations of the San Joaquin Local Health District. <br /> �Z ht ` �i �l `SD.fls.................................................------------------------------------------------------. Owner and/or Contractor) <br /> (Signed)....-- --------r.......�...... <br /> By------- --------- �.i.t...Zt/t�x l t-------------------------....... .---..-----------_----------- <br /> (Plot <br /> --------------------- <br /> (Title)........A �!------- <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... .... ^"cs..L.._..----------..------......----------------..... DATES'-3'40----------_...------------------- <br /> REVIEWED BY.---.--- --------•---------.------- -------------.....-----------------------.........---- <br /> ........ .. DATE----------------------......---......-----....------ <br /> PERMITISSUED........ ---....._--- -----------------....... ........-- DATE...... ------------------------------------------- <br /> BUILDINGAlterations and/or recommendations:..........------------------------------------------i---------...._................................--........................................... ..... <br /> ..................................-------------................................................................................. -----` <br /> FINAL INSPECTION BY:._,4r__ Date.tS .3_..� 0.......- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, California <br />