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2 � � <br /> APPLICATION FOR SANITATION PERMIT Permit No. ✓__3__. ,..._ <br /> (Complete in Duplicate) <br /> Date Issued fa -3--------- <br /> � <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 wt Orclinan No549. <br /> ADDRESSJOB AND CATION----------i <br /> '--- - --------------------------------------------------a------�----- <br /> ---------- <br /> Owner's Name-------- -------------------------------------------- Phon�=_ <br /> ` -------------- -------•------_._.. <br /> ------- <br /> Address------------ ------ Phone4 - --£--------- -------- <br /> Contractor`s Name--- ---- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ________ Number of bedrooms _-__-___ Number of baths <br /> ----- Lot size -44--I-K-04--------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private IV Depth to Water Tableg_Q-__ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 'X New Construction: YesitNo ❑ <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 well_ '"'V_6_,Distancg from founclation_�b-------------Mate Tial_______----____ __..___.-- ---------i, <br /> of compartments_-_-_z---------------Size�o-.'_�_+ 13----- t----..Liquid depth�-"�----------------Capacity-- --�f_-------- <br /> Dispoal Field: Distance from nearest well_ -/Distance from founda� -d 8--------------Distance to nearest lot line----------------- <br /> j <br /> Number of lines--------/----------- ------------Length of each line------ ----- }, Width of trench - ----------------____-- <br /> Type of filter material_ ----------Depth of filter material_ ------------------Total length---/_26_---______-_-_______.._ <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 /> Cess❑pool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material___________-_-_____________-_-_._____. <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line--------- ---------------------- --------------------------------------------------------------------------------------- -------- <br /> All <br /> ,, : <br /> Remodelin and/or repairing (de ribe)•---- --- -- ----_- --- -- -- - <br /> 40. <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 /> ordinances,�ttellaws,, and •files and regulations of the San Joaquin Local Health District. <br /> ----------------------------------------------------------(Owner and/or Contractor) <br /> Si ned _ . <br /> By:------------------------------------------------------------------------------------------------------------------------------------ <br /> Tale <br /> ---------------------------------------------------------------- <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 /> i <br /> APPLICATION ACCEPTED BY DATE-------- - -� <br /> REVIEWED BY-------------------------------------- DATE---- -- c <br /> ------------- - -- - - - --- -- - <br /> >� <br /> BUILDING PERMIT ISSUED---------------- ---- ------ DATE------------------------------------------------------------- <br /> - - -------------------- --------------------------------------- <br /> and/or recommendations:---------d----------------------------------------------- <br /> ------------- <br /> ----------------- <br /> --- -- <br /> ` �` <br /> - -------------------------------------------------- <br /> --------------------------- ------------- sck� ---------------- --- - <br /> C-- <br /> ---------------- <br /> 4 <br /> ;- - --- -- -- <br /> ----------- --- -------------- ---------------------------------------------------------- -- <br /> r.L- ---•------ f --------- ------------------ ------- --�---------- ---------Z <br /> jj_ <br /> N INS41*0 BY---------------------- ---- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 136,6oufih Am <br /> eaican Street 300 West Oak Street 132 Sycamore Street <br /> 8!4 North "C" Street <br /> -• Stockton, an <br /> Lodi, California Manteca, California Tracy. California <br /> 5 � <br /> Y. <br /> ES-9-2M 8-51 Revised W-2100 <br />