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� r' A <br /> APPLICATION FOR SANITATION PERMIT Permit No.'... .� ..... <br /> Complete in Duplicate) Date Issued .. ,� �._.. <br /> ;`01 <br /> Applica+ion is hereby made to the Sen Joaquin Local Health District for a permit t st ct a install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> _�,�p� tt <br /> JOB ADDRE=SS AND LOCATION -. _.._I.... -•--- --....---------- ------• - ..-..---- f <br /> OwnersName.....-.. ...............................--•--•---------- .._.......__.... Phone._'..................... <br /> Address».__ ._.� ..... �...... _.. <br /> - -� /,�/� <br /> Contractor's Name......................,r ',<.: .... � ` ..._ ...................................... Phon ...,.17.__:_(.. _� ....._. <br /> Installation will some: ResidenceApartment House Q Commercial [3Trailer Court 0 Metal ❑ Other [D <br /> Number of living units:.._. Number of bedroom!';';?--- Number of baths Z_-_ Lot sire:.l�Q.�. .lQ,�-......--------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. . <br /> Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam❑ Clay Loam;] Clay❑ Ado6eW Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 9 New Construction: Yesx No ❑ ` <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> l' (Na septic tank or cesspool permitted if public sewer is available within 200 foot.) <br /> 1 � <br /> Septic Tank:. Distance from nearest wall--l-r ---Distance from foundation.JAP....--_.M Iterjal•--.C_-__C_._.___.-.___-___________------ __ <br /> No. of compartments......o .............`Sire .........Liquid depth_ ..---..---capacity... <br /> Disposal Field: Distance from nearest well.- .:_.__Distance from foundation...� .._.._._ Dis#once to nearestlot line./ ..-.... <br /> Number of lines...•---+ -------__��.jj Length of each line.---->3 - - S---Width of trench.__.a-?-�}�..................._._ <br /> Type of filter material.__III.;04..Depth of filter material-A _;_..__.____.Total length.__7_�.......................... <br /> Soepa a Pit. bistance to nearest well..I"-.........-Distance from found tion.. d.____Distance to neares+lot line....`�...�..y <br /> Number of pits-----.j-----------.Lining matenala _.e y. e: Diameter._.s3.3- <br /> .....Depth....a ..................... p� <br /> t Cesspool. Distance from nearest well----------------- from foundation._;;__.............Lining material.....-............................... V ' <br /> [] Size: Diameter------............:......----------.Depth.....................................__-------....Liquid Capacity............................gals. R <br /> Privy: Distance from nearest well.................................................Distance from nearest 6uilding......._.. .....................__...... <br /> Distanceto nearest lot line-----------------------------_-_......................................................................... <br /> IRemodeling and/or repairing (descrihe):.................................................................•---------• - <br /> -. <br /> •------ •-----•-------•----------•---- _ -----_..------------------•-----•----•------­ ............__............................._........_................_......- ...... <br /> .•.................................•-----..................._................--_.._._._..- -• - - - - ............-_..__...-_.___...-...._---......--------•----- -------- l <br /> I hereb certify that 1•have prepared this application and the+tha work will be done in accordance with San Joaquin County•-� <br /> ordinances, to.lawwss,,and rules and regulations of the San Joaquin Local Health District. <br /> .......................... ---•-•- - --.[Owner and/or Cafraat <br /> ..........................--- _-_---_---1+101_...... --- t---------.....---....._..., ............ <br /> [Plot plan,showing sae of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse sidel ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------:-....... _ ...: .-----•-•-•--......•-----------•---•-------------•------ DATE........ ........� . - ,:;�- <br /> ------ <br /> REVIEWED BY.............. _-------------••-•--------•---•-•-- DATE--.----- >/ ....-.._...---•-•------- <br /> -..-.. <br /> BUILDING PERMIT ISSUED......................... ...... ... . .............--..-.......-- ..._.... DATE__...... ...r_ti. ..._._._..__ <br /> Alterations and/or recommendations:............ .. ..._..------.._.............---------......--..-....:---------------•----.........:...(/. ........_ --- ... f <br /> .............. ._-•--------*......._. .............,.:w.-.. ,... _ _ _......_.. ........................ <br /> 7 --•-•-------------------•--------------- -------- - <br /> -- <br /> 6 _._..:... �.. � ------------------------------------------ - , <br /> - <br /> .. = --------------------------.-------.........-----------------------------•._-.-.-_.......... <br /> ......................................... ..T -------------------------..-_.-------.............---- -- -----------------...---.....----------......� ................................ <br /> FINAL INSPECTION BY:...-- Date....... .,..... ........ ,. .............. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Arnarrcan Street 300 Wes+Oak Street 132 Sycamore Streat 814 North "C' Straaf <br /> Stockton. Califomis Lodi, California Mantaea. Callfornra Tracy, California <br /> Egra 10446 ATwooa <br /> r <br />