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APPLICATION FOR SANITATION PERMIT lQ <br /> Permit Na. . --7___._..- <br /> f� (Complete in Duplicate) Date lssued":"�l_` <br /> Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is mde in compliance with County Ordinance No. 54F. <br /> JOB ADDRESS AND LOCATION........ a.-------k�-f----- -- ---------------- --- __�'`.' <br /> ��rr j <br /> ---s 1 - ---- ------ Phone <br /> Owner's Name----------------•---------------- ---- - - ----- --- - -='--------- - - <br /> Address----------------- �x_�_`�- :_&- - -- ------ ---- ! t <br /> Contractors Name_. ---- <br /> b ?1�t.A u - Phone----•-f---- Q <br /> Installation will serve: Residence IX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -__ Number of bedrooms -1---- Number of baths /----- Lot size ___a – ------------------------ <br /> Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table 49 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ <br /> Previous Application Made: Yes ❑ No J& New Construction: Yes ❑ No ❑!&-�aAj, S <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic Ta-gk: Distance from nearest well________________Distance from foundation___________.-------Material__.________._-----_-_.__.--_____-_---..---_-__-. <br /> I -114 9 No. of compartments------ -- - ------------Size--------------------------------Liquid depth---------- --------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_____--..-______- <br /> ��4 Number of lines---------------- ------------------Length of each line------------------- ----------Width of trench---------------------------------- . <br /> Type os filter material---._.-------------------Depth of filter material-----------------------Total length---------- ------------- <br /> Seepage Pit: Distance to nearest well- . <br /> .t(aA_ ------Distance fro _foundation_ 9 ----------Distance to nearest lot line__.6__------- <br /> Number of pits------I--------------Lining material__ __-- t.-----Size: Diameter-.4-3-.19------- Depth-_42-f------------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation---.-.____-____---.Lining material--.__-_-_----------______--_.____-_ <br /> i <br /> ❑ �r' 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 idescribe):---------------------------- •----------------------------------------------------•--------------------------------- -------- <br /> •-•--------------------------------•---------------------•-------------------- <br /> --------------------------------- -- ------------------------------•-------------•--------------------------------•-------•--------------- ------•---------------------------------------•-------------------------------- <br /> ------- -------------- -------- ----- ---------------------- ------------------------------.-...-------------------------------------------------------------------------------------------------------------- <br /> I hereby cerci t t I have pre red this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat and rules an regulati ns of the n Joaquin Local Health District. <br /> ° (Avner-apeVor Contractor) <br /> _ - - - - <br /> (Signed) <br /> --- ---- ----------------------- <br /> By: (Title -4- <br /> (Plot <br /> =' '4±<tJ <br /> -- - -- - - - - --------------------------- -- -(Plot plan, showing size of lot, location of system in r tion to wells, ildings, etc., can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> ---------- ----- DATE-------- - <br /> APPLICATION ACCEPTED BY----- ------------------------- ----------------- s-;5- ' <br /> REVIEWED BY----------------------------------- ----- ------------------------------------- DATE-------- -------- <br /> ot <br /> BUILDINGPERMIT ISSUED---------------------------- ---------- DATE------------------------------ <br /> Alterations and/or recommendations----------------------------- ---------------------•----•-----•------------------------------------------------ <br /> -------------------------- <br /> --------------------------•------•---------------------------------- ----------------------- ------------------------­------•....... <br /> ----------------------------------- ---- ------------- ------------------------- <br /> FINAL INSPECTION BY:. " vgLC 11�'J Date --------� ---------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> rc—Q –?1..1 Revised W-2100 <br />