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• APPLICATION FOR SANITATION PERMIT Permit No_ ________________________ <br /> (Complete in Duplicate) ef/ <br /> Date Issued __ __ ,--------__ <br /> Application 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 wi h ounty Ordinance, No. '549. <br /> JOBADDRESS LOCATION. = ------------------------- ----------------------------------------------- <br /> t - , /• gyp <br /> Owner's Name 'V7 -� -"�� <br /> TEX ° L.L3iI .. Phone-------`-« <br /> Address ,.-- ; {- <br /> Contractor's T <br /> Name---------- - G ---------- �'------------------------------ Phone--------...------------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherI <br /> Number of living units: --j--- Number of bedrooms ---- Number baths ___(____ Lot size ____ __ __�` ______________________ <br /> Water Supoly: Public system ❑ Community system ❑ Private epth to Water Talo _ 4ft. <br /> I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Ad oba Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No R-IFHA/VA: Yes ❑ No <br /> r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public <br /> fiewer is available within 200 feet.) 1 E� <br /> t Septic ank: Distance from nearesT well-_-��_-__Distan e lfromlfou dation-_. _____.Mat ri�l______ ,_______. (j <br /> No. of compartments_.___. - Size-- Liquid deqth__.____ -_._________Capacity---- __ <br /> Dispos Field: Distance from nearest well-_; _--_Distance from foundation--- -_.----Distance to nearest lot line---E-_______. <br /> Number of lines--------- _______-- Length of each line------- Width of trench._ <br /> --------. r--------------------- <br /> I Type of filter material_____ Depth of filter material_._.___ _________Total length________ _________________________ <br /> Seepage Nit: Distance to nearest well---------------------Distance from¢foundation__________________.Distance to nearest lot line------------------ <br /> ❑ Number of pits-----------------------Lining material-:_'__- _'--------Size: Diameter--------------.--------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-------------------------- -_____. <br /> ❑ Size: Diameter---- ----- ------ I� „ a igyic{.,Capacity gals. <br /> Privy Distance.from neareSj well--- � rna 5 �b c- -- <br /> �, <br /> 1 ❑ Distance to nearest.Iot line -- _; * n <br /> k 7 <br /> Remodeling and/or repairing (describe):---------------------- ----- ----------------------------------------------------------------------------------------------- ----------------------- <br /> 1 r <br /> ------------------------- -------------------------•-^--------------------------------------------------------------------------------------------------—---------------------------- <br /> ------------------------------------------------------= -----------------------------------•----------------------------------;::---`------------------------------------------------ ------------------------------- <br /> I hereby certify that I havd'pre ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S to laws, and rules i regulations o ,the San Joaquin Lo a{ He Ith.Ais pr.. <br /> (Signed)-- - ------.-- _ _----' ----------------(Owner and/or Contractor) <br /> ---------- /-------- --------- - - --------------�----- <br /> By:- ...----------------­- ---------- ------------------------------------------------------- Irt a ----------------------------------------------------- <br /> 1 (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 /> APPLICATION ACCEPTED BY------------- -- --- -- -- ------ ----------------------------------------- DATE--- <br /> tREVIEWED BY---------- ---•------------------------------ -- ------------------------------------------- DATE- - --------------------------- <br /> BUILDINGPERMIT 'SSUED--------------------------=-- ---- --------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations <br /> ------- ------------------------------------ <br /> Alterationsand/or r commendations----------------------- ---- --------------------------------------------------------------------------------------------------------------------------------- <br /> -- ------------------------------- <br /> ------------- --------------------------------•--------------- <br /> ------------------------- ------ --------------------- -------- <br /> --- - ---------------- <br /> - L,�r�- ---- ------ <br /> -----•-------------------------------------- - ---------------- - ----- <br /> FINALINSPECTION BY:----- - ------- ------------------------------- ---------- Date-------------------- ---------•--------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street s 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> la d <br /> t LS-9-2M Reviseo 1.57 F.P.00- <br />