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APPLICATION.-FOR SANITATION PERMIT. Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applicafion is hereby made to the San Joaquin Local Health District for a permit to constr t nd i tall the wor herein described, <br /> This application is made in compliancqwitCounty Ord ante No. 549. 10C> <br /> JOB ADDRESS A D" LOCATIO ,� ---- - ----------- 'Owner's e -- ---- ---------- -•-•- --------------------------- --- Phone- <br /> Address_ ` + .- a?-- -- - -------- ------------ <br /> } <br /> Contractor's Name. tl 1�_° ----------•---------- ------------------ --------------------------------•----•------------------•---- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail Court E] Motel E] O her IQ <br /> Number of living units: Number of bedrooms --74- Numberbaths . Lot size <br /> Water Supply: Public system E] Community system p Private `Depth to Water Table!Yt!ft, i <br /> Character of soil to a depfh.of 3 feet: Sand E] Gravel [—] Sandy Loam Ej Clay Loam ❑ Clay ❑ Adobe ®Hardpan ❑ <br /> Previous Application Made: -Yes E] No V New Construction: Yes [ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pudic ewer is available within 200 feet.) W <br /> Septi 'Tank: Distance from nearesr well- 4 Dist nke fro found, n--- __ Mater' IF_----------------- -___._._----_,r_-_-_-_-----. <br /> No, of compartments _. <br /> P Size iquid deth- a Capacity <br /> Dispos Field: Distance from nearest well _ Distance from foundation.-_ - Distance to nearest lot lin _ <br /> ,�--- --------- <br /> r p 1p <br /> Number of lines_ t____s __ __...________ Length of each line_____._../___ _ Width of french--------- _______ <br /> _ <br /> Type of filter mate'ri8' � ��' •epth of filter material------ .____.___Total length--------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------t------Distance to nearest lot line--_----.--_---__• <br /> ❑ Number of pits-----L-------------Lining material-----------------------Size: Diamefet, --�_'_IP'!----- Depth--------------------------------- <br /> Cesspool: Distance from neatest well-_-_--_-.___---_Distance from foundai-ion-_.---_____I__ ___.Lining material-------------------------------------- <br /> ❑ Size: Diameter ----- --------------------------Depth-----------------------•---------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distancefrom Snearest building-----------------------------------------. <br /> ❑ Distance to neares "Ibt line"-._."_"-._ ----------�-- --- •��^--' <br />� a <br /> Remodeling and/or repairing (describe):------•-- --------------------------=---------------------------------------------•----------- ---------------------------------------------- •-------- <br /> } ri. <br /> -------------------------------------••---•-------------------------—;---------------------------••---•-------------------------------------------- - - <br /> ------------------------------ <br /> 1 <br /> -------------------------------------------------------- =- <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, Stale laws, and ales and regulations of the S quin Local Health District. <br />' (Signed,. <br /> ----------------------------- <br /> g }Owner and/or Contractor} <br /> 1 B ------------------------------ }Title) I <br /> 1- y________________________ __________________________________k_._._.___._..----___- __ -----------____----._-_.._. <br /> (Plot plan, showing size of lot, location of systemiin relation to wells, buildings, etc., can be placed on reverse side). <br /> I 'FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------------- ------------------- -----------------------------•------------- A%' TE�-----------------------------------••---------- <br /> - <br /> REVIEWED BY •------------------------------------------------------------- DYNE-- <br /> BUILDINGPERMIT ISSUED------- --------------------------------------------"------------:----------------. DATE---------;-,_----------------------------------------------- <br /> Alterations and/or recommendations----------------------------- }`'` "` 1__­.-_-_-__-___1.--------•----------------•-------- -- <br /> _.-----•---------------------------------•-------------------------------------------------------------------------•--•-------------------------------------------•--------------------••-----------------•---- ------------ <br /> ------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------•----------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------- --- --------- <br /> !! C r <br /> FINAL INSPECTION ''BY:. .- --- ----- Date <br /> - - -- -------------------------------- <br /> t: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfreef 300 West Oak Streef 132 Sycamore Sfreet 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California , <br /> ES-9-2M 10-52 Revised W-2100 x <br /> i� <br /> Ilk r <br />