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APPLICATION FOR SANITATION PERMIT Permit No.------- ------L y--- <br /> (Complete in Duplicate) Date Issued ----s t <br /> Y„ <br /> Applica+ion 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. I <br /> j� <br /> JOB ADDRESS AND OCATION-------l-�-�--------�l�--------- 1 /�--- -----------------•--------­-------------------------------- <br /> Owner's Name------- 4::�94A/----------/.�.(------- ---- --------------- ---:-------------- ---------- -------------- Phone------------------------------------ <br /> Addressr . : ----------------------••---------------------- <br /> Contractor's Name-------- -------'t3— - -----r------- --------------------------------------------- Phone---------------------------------• " <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:3-7--- Number of bedrooms - -- Number of baths - Lot size _-r1�--a 255?------ a_______________ <br /> Water Supply: Public system KL 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 9- Hardpan ❑ <br /> Previous Application Made: Yes ❑ No PS—New Construction: Yes ❑ No4KL- <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 weh__�,V_ _d?u4Distance from foundation__.-:2_t0__.`.___.-_`. Material--- --_.-. <br /> No. of compartments_..-_c ---- ----- -----Size__.;0_7Z7_2'-_'7X_ L uid depth---�1-..------.-Capacity--- <br /> Disposal <br /> Field: Distance from nearest well_W.4- LJ)istance from foundation-. .Distance to nearest lot <br /> Number of lines-------- -------- _��-------Length of each line----------�-a_'___.Wiclth of trench-._- -_ -��-----.---- <br /> Type or filter material--_ --- 5i epfh of filter material-.- -- .---- Total length------- d--- ---------------- <br /> _1J5 <br /> - i f <br /> Seepage Pit: Distance to nearest well.. ---- --�,7-L.9,Dastance from foundation--_�!F -___. <br /> Distance to nearest lot line_z. 4._ <br /> QJ � <br /> Number of pits-_�-----------Lining material-��-z�1 -Size: Diameter--- Deptn---- _°-----.- i <br /> Cesspool: 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 /> ❑ Distance to nearest lot line-------- - ------------------------------- --- ---------------•--------------------------------------------------------------------- -------- <br /> Remodelingand/or repairing (describe):------------------ ---------------------------------------------------------------------------- -------------------•-----------------------•--••-------- <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, Stat ws, and rules and regulations of the San Joaquin Local Health District. <br /> f <br /> �.s <br /> (Signed)--- �Cr -- ------ ----- ------- —-------------------------------------------------- --------------------------(Owner and/or Contractor) <br /> (Plot plan, showing size of lot, [ocation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> S_ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- --- - ---- ----------------------------------------------•----------- DAT ----- ---- - '. <br /> ----------- - <br /> REVIEWEDBY--------------------------------------- - .- ---------------------------------------------------------------- DATE -r-------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------- -•----- - - DATE-------------- ---------�S --------------------------- <br /> Alterationsand/or recommendations:----------- --- ----------------------------------------•------------------------------------ -------------•----------------••-.----- <br /> ------------ <br /> --------------------- �C-c i f N- ------ <br /> ------------- <br /> -------------------------------- ---------- -------------------------- <br /> -----------------­- <br /> -------------------------------------------•- ------------------------------------------ ---------•-- ------ <br /> FINAL INSPECTION BY: ------------------------------------ Date--- <br /> - ' -----------------------------------• <br /> L.T__� T. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r <br /> wsnulh:American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> ockton, California— �;�Lodi, California Manteca, California Tracy, California <br />