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r APPLICATION FOR SANITATION PERMIT Permit No. ._2L.1.. ... <br /> (Complete in Duplicate) t S <br /> Date issued __I-�_._ <br /> -yApplica}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. <br /> JOB ADDRESS AND LOCAON- ­tAn-,". 0— <br /> ------------------------------------------------------•--------- <br /> Owner's Name------ - • -----------jA— --------.._ ------------ -- Phone------------------------------------ <br /> Contractor's Name--• � � /---- �t/°r. , �? � Phone <br /> Installation will serve: Res-:dente P-1-par+ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms -2�Number of baths ----I- Lot size ------ - ._.�,-----__________ <br /> r- <br /> Water Supply: Public system ❑ Community system ❑ PrivateA Depth to Water Table .eft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0- Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Pd_ New Construction: Yes ❑ No 4, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: - istaRce from nearest well__.__---_-._-__-Distance from foundation--.----------------Material-__-__._..__._____-__..___.--____-_._----__._. <br /> ❑ o7�Aeompartments_ -------------- ---Size--------------------- ---- <br /> -•---Liquid depth----------- -------------Capacity----------------------- <br /> Disposal Field: 'Dist4mce from nearest well-................Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ kAB-e—r lines-------------------------- -- -----Length of each line------------ ----------------.Width of french----------------------------------- <br /> Type i ter material-------------------------Depth of filter material-----------------------Total length________---___-_________________- ---.__-. <br /> f I - t <br /> Seepage Pit: Distance to nearest well..,)-60-:------Distance from foundation-___��2_____..Distance,j to nearest lot line----l/1.___-.. <br /> p 1-__.-._._.__Lining material____ !�_ �zelDiameter.__-. ___ . <br /> Number of its 5- :� -----Depth---- ` � ------------ <br />` Cesspool: Distance from nearest well-----------------Distance from foundation .................. Lining material-__----_.._--__.__.___._______--.__ <br /> ❑ Size: Diameter------- ------------------------------Depth----------------------------------------------------Liquid Capacity------------ •-- -------- al,. <br /> Privy: Distance from nearest well---------_--------------------------_------------Distance from nearest building--------------------_--------------------- r <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 aw , and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-------- ( - - --------- ---- ------------------------------------------------------- --------( weer and/or Contractor) <br /> By:-- <br /> � = yr --------------------------- <br /> --•------- ------(Title)- ..... --- -------------------------- <br /> (Plot plan, showing size of lot, location of sys+em in relation +o wells, uildings, etc., can be. placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------- ----- - --- -------- - ------------------------------------------------ DATE--;,�---•---- ------------------------------------------ <br /> REVIEWEDBY-------------------------------- -------- ----------- ----- --------- ------------------------------------------- DAT --------<- -------------------------••-------------- <br /> BUILDINGPERMIT ISSUED-------------------------- ------ ---------------• ----- ---- -----• DATE------ ------- ---------------------------------- <br /> Alterations and/or recommend ations:,en------------- ----- - a1., ------------------------------ <br /> ---- -- - ------ ----- <br /> ------------ <br /> ---------------------------- <br /> ---------------------------------•--- <br /> FINAL INSPECTION BY:.--z---^---2•�-v----=------------------------------- 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 /> E5-9-2M 145446 ATWOOu 12-54 <br />