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APPLICATION FOR SANITATION PERMIT Permit No. J -3 57t <br />(Complete in Duplicate) z <br />Date Issued _�/___Z1--G/. <br />Applica'•ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ94,,e,, <br />This application is made in compliance ith County Ordinance No. 549. --�, <br />JOB ADDRESS AND LOC TION - --- - ----------- --- ---�-- .....�' .7!4e-`f�/+.'''�'�" ' <br />Owner's Name l/!/ ----- --- !--------------- ------ Phone ------------------------------------ <br />Address--------+ .2....-P.Y----aX--7--�-----------------------;-------------•- <br />Contractor's Name ---------------------- - ------ Phone_ ..--------•---------_---------- <br />Installation will serve: !Residence Pq Apartment House-[] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />4. <br />Number of living units: -------- Number of bedrooms 3__ Number of baths __27--- Lot size ___J!1 .. �_ . - _ _ :_ <br />Water Supply: Publicystem ❑ , Community system ❑ Private CK Depth to Water ft. " <br />Character of soil to a depth. of 3 feet: Sand Gravel ❑ Sand Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br />P ❑ Y , <br />Previous Application Made: Yes ❑ No R New Construction-. Yes X No ❑ : <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic, tank.or cesspool per'mlitted if public sewer is available within 200 feet.) + <br />Septic Tank: 'Distance from n arest we I_--���_--_ Distan Afro foundation__AP__-______. erial__ __ _ _ _ _ ____-- <br />No`..of comparnts._Size-__---- Liquid depth_____ ____________Capacity:_�___ <br />--- <br />Disposal Field: .Distance from nearest- well _s'rd_...... .Distance from foundationI_U-______- Distance to nearest lot line__�_�_----__- <br />:'1Nur�riber of lines_______ _ __,�______Length.of each line________ ___ `� /Vidth of trench <br />-- <br />Type of filter materia �f_Depth of�filter material_ ____'_.;}(__Total length___ <br />Ae ------ <br />Seepage Pit: Distance to nearest wel ______________________Distance from foundation ----------- ----- Distance to nearest lot line_______, ________ <br />❑ `Number of pits-------------�_---`4 Lining material_-----------:_. --- Size: Diameter ------------------------- Depth -------------------------------- <br />Cesspool: Distance from nearest well ----------------- Distance from .foundation --------------- .'.,_;Lining <br />, .-: material_ <br />_______.-____.._____________-____---_ <br />❑ Size. Diameter --------------------------------- -- --- - -:.-Liquid Capacity ---------------------------- gals <br />. <br />Privy:DiOance from 'nearest well---=------------:-------------------------- ----Distance from nearest building -----------------------------------------. <br />❑ —Distance to nearest lot line--- ------ ------------------------=-w-------------------------------------------------------- --------------•-••---------=--------- <br />Remodeling <br />and/or repairing (describe)- ------- ------------------------------------- --................. ---------------- ------- -----------•-------------------------- ------------------------ <br />---------- ---------------------­--- t <br />--------------------------•----------•---•------------------------------------------------------------------------------------------ ....... ------ ------------------------------=-------------------------------------- <br />----------------------------------------------------------------------------------------------------------------------------------------- - <br />1°hereby certify +haul have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules <br />/aand regulations of the San Joaquin Local Health District. , <br />(Signed) W. .1441�_,_ ---- ______ ______________ Owner and/or Contractor JI(o <br />IB - -- . --- ----- ----- t -------------------- ----------------- -----------------------•--------------- - ----------------- <br />(Plot <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 1 <br />APPLICATION ACCEPTED BY .- ------- --------------------------------------------------------------------- DATE ---- --------- - <br />- --------------- <br />REVIEWED BY = = DATE ---------------------- <br />---------- --- --------------------------------------------------------------------- <br />BUILDIN� PERMIT ISSUED.-----••----•-• - = DATE-------------------- = <br />- <br />Alterationsand/or recommendationsi-----------------------------=--------------•--------------------------------------------�------------.-----------------------•-------••----•---------------- <br />�-- '----------------------------'--------- --------------- : ---------------------------------- ---------------------------------.--------•-------•--••--••---•-• - ----------••------------------------------------ <br />---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- <br />------------------- <br />-------------- <br />------------------------------------------------------------------------------------------- ..--------------------------------: ------------------------------------------------------------------ <br />FINAL- INSPECTION-..BY:.� - -- ---------- ----- -='` {" Date.:. ,% ^fP.l.- <br />130 South American Street' <br />Stockton, Cafifornia <br />c: <br />/ S -9-2M Revised W-2100 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 132 Sycamore Street <br />Lodi, California Manteca, California <br />814 North "C" Street <br />Tracy, California <br />