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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued -------- '--- .. <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit f construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 7 D-B ------------------------------------------------------------------------------------ <br /> JOB ADDRESS AND CATION___.�r�l�--..--�--=-- ----- <br /> '� _ s 0A/ Phone <br /> y�/�/�C --------------------- -- <br /> Owner s Name------a_ .�f!_'_f_.[�J----------=------f--�-�---•---------------•-------- ------- -- ----- ----- <br /> Address-----.--- � Ic . -----------------•---------------•--------------------...-------------•------------------ --------------._... <br /> i� r Phone//6..�_ _. ------- <br /> Contractor's Name..—O"-w- eKL' -=5-�--- --• r ` ----------- ----- <br /> Installation will serve: Residence ❑'Apartment House (ICommercial F] Trailer Court [3Motel ❑ Other ❑ <br /> Number of living units: _- - Number of bedrooms ___ . Number of baths -_!____ Lot size _._ --------f- r <br /> -•-------------- <br /> Water Supply: Public system [vrComrnunity system•❑ Private ❑ Depth to Water Table -------- ft. R <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe©- Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 0-'New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet:) <br /> Septic Tank: j Distance from nearest well-- _______--___Distance from foundation___________________Material-------------------------------------- <br /> ----------- <br /> ❑j}�1 3 1 ' No. of compartments-------------------- Size------ ------------- -----Liquid depth--------------------------Capacity----------------------- <br /> _______Distance from foundation_______._____....-_-Distance to nearest lac line----------------- <br /> Disposal Field: Distance from nearest well__________ <br /> I <br /> ❑ I zi—' Number of lines------------------------------------Length of each line------------------------------Width of trench ; <br /> Type of filter' material----------------__ -Depth of filter material--------___________-_Total length------------------------------- <br /> Seepage Pit: Distance to nearest ell_110_hr�_---Distance f 2 m foundation_ d_._/....Distance to nearest lot line---- �____ ` Q <br /> Number of pits.--------1-----------Lining material--- rC- <br /> ---Size: Diameter---- .. -i�--_- -Depth--- -5-- ------------------ <br /> w " <br /> Cesspool: Distance from nearest well________________ Distance from foundation------------------- Lining material------------------ <br /> Depth <br /> ElSize: Diameter------- --------------- -------------- ----------•----------------------------------------Liquid Capacity-,--------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildi.6g------------------------------------------- <br /> ❑ Distance to nearest lot line----------------------- ------- <br /> ------------------------------------------ <br /> ----- C L... .Pf 1. '1 --------=- - ----------------- -------------- <br /> - <br /> Remodeling and/or repairing (describe): ----- ------ <br /> ------------------------------------•--------------------------------•----------•------------- •------------- <br /> -----•-•-•--------------••-------------------------- ,. <br /> - A <br /> --------••---------------------------••-•-------------------•-------------------•---------------•-------------- <br /> ---------------------------------------------------------------------------------------------------__ <br /> 4 <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, States auks, and rules and regulation the San Joaquin Local Health District. <br /> ` { <br /> (Signed}_ -fA2 ,I--- �1,% ,( ner and/or Contractor) <br /> v A ----------- ---•-------•------- ----------------(Title} <br /> ------------------------ <br /> By.__.____�_ <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 <br /> APPLICATIONACCEPTED BY-------------------------- -- --- ------ ---------- --------------------------------------------------------------------- DATE------Z------- --------------------------------------- <br /> REVIEWED BY DATE------ -/—---------•----•--------------------- <br /> - DATE <br /> BUILDING PERMIT ISSUED------------------------------- --- r <br /> Alterations and/or recommendations:------------- ------ ---------------------- •--------•-••------ -- --•--- ---- --�-------------••-------•- <br /> ------ ••-------------•- <br /> ------•------•--------• ------------------------------------------------------------------------ <br /> :__---------=------------------------ <br /> Date_. : ......... ----------------------------•---- <br /> FINAL INSPECTION BY: I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street r 300 West Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> :1 Es�J—ZM 145446 ATwano 12-54 <br />