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APPLICATION FOR SANITATION PERMIT Permit No. -II-,--_________ <br /> (Complete in Duplicate) Date Issued�wZ__(_(--S/ <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 County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_____________________________U U-Harbor-_Ra------------------- <br /> ------------------------------------------------------------------------- <br /> Owner's Name-------------- r----P-`-----H.---MaHugh-------------- t{ '1 i' 2 <br /> -------- - - - --- - ------------- ---------------- Phone----------------------------------- <br /> Address---------------------1525 Harbor Rd. <br /> - ------------------•----------------------------------------------------------------------------------------------------------------------------- <br /> 3�e1ta ' <br /> Contractor's Name--•------------------------------------------------------------------------------------------------------------------------------------------- Phone------�_-����------------ <br /> Installation will serve: Residence [I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1__-- Number of bedrooms ____2_ Number of baths __Z___ Lot size --------------50-XI-0-0 <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 ❑ Adobe[?� Hardpan ❑ <br /> 1 <br /> Previous Application Made: Yes ❑ No []c New Construction: Yes ❑ No <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-----------------Distance from foundation--------------------Material------------------------------------------------- %A <br /> E-&Ib`T:4;G No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_________________ <br /> EX16T iVIrz' Number of lines---------------------------- <br /> --------------------------------- -Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material----------------------- length------------------------------------------ <br /> Seepage <br /> __________________________ _____________Seepage Pit: Distance to nearest well__________*-_______Distance from foundation______' -- <br /> ------Distance to nearest lot line �t=---------- <br /> !] Number of pits--------1-----------Lining material------b' i Size: Diameter-3-91 <br /> - ete --------------Depth---11---------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> F Size. Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------.______-_______- <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and//or repairing (describe):____Install_i__nR new__v_ertiC I dri�in-__on1�y-... ndklook 2l __u-o -.. <br /> to the exisitnR seiatic tank *ith solid Zine <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) belt Owner and/or Contractor + <br /> By:---------------Zg-UY-_ ,rthan --y <br /> .:��;____________________------_____-____----_______________(Title)----dwner---Ngr------------------------------- <br /> (Plot <br /> -------_----------__(Plot plan, showing size of lot, location of s)stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------------------------------------------------------------------- DATE------3 ------------------------------------------------ <br /> REVIEWEDBY---------------------------------- ---- ------------------------------------------------------------------------------- DATE--------- <br /> BUILDING PERMIT ISSUED----------------- ------------------------------------------------------------- <br /> - - ---------- DATE- -------------->--------------------------------------- <br /> Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------------------------------------------•-------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------•---------•-----------------1---------------------------•------- <br /> -----------------------------------------------------­----------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------=---------=-------- <br /> r <br /> �- / , z � �------------- --------------- <br /> FINAL INSPECTION BY:____-____;� �___-�_� Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stree+ 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> a <br /> ES---9---2M 8-51 Revised W-2100 <br />