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APPLICATION FOR SANITATION PERMIT Permit No. <br /> p <br /> k�omo�� � <br /> K ^ -`'- Duplicate)- Date Issued <br /> plical-ion is hereby <br /> made to the Son Joaquin Local Health District � o permit toconstruct and install the work herein described <br /> Th . <br /> 'sapplicationh made in compliance with County Ordinance/No. <br /> JOB ADDRESS AND LOCATI <br /> - � � � � � a�Contractor's Nume----.- � �. � . = . . ---- --_-- .�� r� GInstallation will serve: Residence �xApartment House Commercial [] TrailerCourt [-] Motel [] Other [] <br /> ' <br /> � � <br /> Number of living units-. xK-.. Number ofbedrooms 'm�u' Number of bu+6, -'^.-' Lot `|u, -..��-.���� --' ^ <br /> Wafer Supply: Public system f VY <br /> Community system E] Private [l Depth to otorTub|e���^ft <br /> ^ <br /> ' ~^" <br /> Character of soil to o depth of feet: 3on6 E] Gravel [] Sandy Loom [-I Clay Loom [] Clay C] Adobe Hardpan [] <br /> Previous Application Made: Yes E] No �` New Construction: Ye, E] No E] ��- ���°~~�' '^��* y " Ar <br /> *� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - <br /> (No septic tank or cesspool permitted R public sewer is available within 200 feet.) <br /> Sqptk k: Distance from nearest well-----------------Distance from foundation--------------------Material ---------_______ <br /> No. ofcompartments--------------------------Size--------------------------------Liquid depth-------------------------- ----------------------- <br /> Disposal F-i&ld: <br /> Distance from noo,o,t weU-_---Oidnnce from foundation--------------------Distance to nearest lot line----------------- <br /> Number <br /> .-'-''_Nvm6cr of lines------------------------------ ----Length of each line----------------------------- of trench'--.'--_.'-'''_ <br /> Tvoe of filter moforio| <br /> ,----Depthof fi|for mufe�a| Jof | �mof --------------------------------------01 <br /> Seepage Pit: Distance to to _ <br /> Number of Lining mm+n�o| Size: Diame+e ---D*o+h..2�-----_--_-ET <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.------------------Lining material ----.-._.__ <br /> D Size: Diameter'-',-'-'''-''''-Depth----------------------------------------------------Liquid Capacity-- ------------------- <br /> Privy: Distance from nearest well '_-_------------------ ----- ------- Distance from 'nearest building------------------------------ ---- --- <br /> 17 Distance to nearest lot line------------------------------------------------ <br /> and/or repairing (deoc66s):------- -------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------^'--'--'''--'''--'-----'------' <br /> ---_.-_-__.-.----___--_-.__'-''-_-.___--___--.__...__-..__-_--__._---_-._-..-_--__'_.. <br /> ------------------------------- :----�AI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances. Stzfte laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot. location of system in relation/f'o wells, buildings, etc.,'can be placecl�o`n 'reverse 'side). <br /> FOR DEPARTMENT USE ONLY <br /> ACCEPTED BY.'''-''--'----''''-'--�� - /�-_.-'-_--''--' D�TE--'---�,=^ ___ <br /> REVIEWED 8Y.--'__-__-----_---------'11----------------------------------------- DATE--.-------_------_-_'-L_._. <br /> BU|LD|NG PERMIT ISSUED--------------------------------------------------------------------------------------- ------------ DATE'---'---_----''-''_-______ <br /> Altwrmtions and/or ,ecommendations:------------------------------ -------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------'---------'-----'------- <br /> --'-'-''-'-''-----''---''''—'''-''-'-''--'''---'--''--''--'---'-'--''''--'-'''-''---'---'--- <br /> --'--------''—''-'''----''''-''''-'''--''''-'-'-''--'---''-'''--'----''---'''------'-''----'- <br /> --'--''''''''--��-�'�------_-''_.-''- ''_'''-'''---'---''-''''-''--'''--'''--'''-'-'''-''-'-' <br /> FlN/\L INSPECTION QY-------------------� -!.�.�M��-----.. Date-------------------------------------------------------------------------------- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South *°",icw" Street 3vuWest Oak Street mu Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />