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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ---- <br /> Applica,lion 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 ND LOCATI.QN.., WVAI ------------ —------4w- <br /> ----AW �Z q <br /> Owner' N --- A*- .-/------ - ---------- _7Phone---- ... ........ <br /> — l.F-C, <br /> -- --E- ------------------------------------------------------------- <br /> Address_ `_1772&_....i�Vi IV/. . . 0?!?! <br /> Contractor's Name...------.10 ------ _ - ----- ---------- Phone----------------------------------- <br /> Installation will serve: Residence [] Apartment House E] Commercial E] Trailer Court El Motel 1:1 OPbr <br /> Number of living units: -/--- Number of bedrooms -/--- Number of baths .-/-- Lot size --- <br /> Wafer Supply: Public system 0 Community system El Private @��Depth to Water Table�V_ _ ft' <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam Clay E] Adobii e?- Hardpan ❑ <br /> Previous Application Made: Yes E] No P-' New Construction: Yes n No 9-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> _V of <br /> ------- 'ist from foundafi <br /> Septic Tank: Distance from nearest well- D ance on---/ ----------M ferial-----e. ....... - - ------------- <br /> I <br /> No. of compartments--., depth___ -----------Capacity.'We------- <br /> Si e dr, <br /> Disposal Field: Distance from nearest well./e0._/__Disfance from foundation_/,',Jr---------Distance to nearest lot line--/P------- <br /> Vr" Number of lines--------/----- I-/".- -.Width c, <br /> Length of each line---- f-trench.......0.�,----------------- <br /> _Z--------------------- <br /> & .....Total length-----/ -_ <br /> Type of filter maferial&�.x_ 1-0- &pth of filter material-- .9020- <br /> ce to nearest 16f line.. -._.__---- <br /> Seepage Pit: Distance to nearest e ---------------Distance from foundation----y ----jpyw <br /> Number of pits.-- - -------- <br /> V� 4i - . ming maferial_V!5�A _W Size: Diameter, .__- ----Dept h- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation............------_Lining Lining material------------------------------ -❑ Size: Diameter---------------- ----------Depth-----------------------------__---------- -------.Liquid Capacity. .------------------------gals. <br /> Privy: Distance from nearest well... .. ....................._..Distance from nearest building------------ ---------------------------- <br /> F-1 Distance to nearest lot line------ --------------------------------------- ---------------------------------------------------------- -------- ----------------( <br /> Remodeling and/or repairing (describe):------- <br /> ---------------------------------------------------- <br /> --------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ----------------­ <br /> -----------------------I------------------------------------------------------------------------------------------------------------------------------------------­--------------------•---------•------------------------- <br /> I <br /> --------------I------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed].......... -------------------- (Owneirem", Contractor] <br /> zBy:_----------------------------- ---------------- --------------- <br /> eils. Ui <br /> 'I <br /> (Plot plan, showing size o��ocafion of system in relation 0 wells, uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ------------------ - ----- --------------------------------------------------------- DATE------------- -------------------- <br /> REVIEWEDBY------------------------------------- ----------------- ---------------------------------------------------------------------- DATE---------- -------------------------- <br /> BUILDING PERMIT ISSUED------------------------ <br /> --------- ----- DATE----------------------------------------------_------------ <br /> - -----j---j---------------- <br /> Alterations'and/or recommendations: P-1. -------------------------------­------------ ------­----­- ---------------------------------------- <br /> ------------------------ ........ -------------- ---------------------- ------------ ------- - <br /> -------------------------------- --7 4" --- --- &vwp------------ <br /> --------------------- ----- 0..... ----------- - ----------- ------------------------------------------------------ f---------------------------------- <br /> -- ----- --------- - ------------ ---- ---------------- ------- <br /> --------------------- --------- ------------ ------ ---- ------- -- --------- ------------------------- <br /> -- ------------------------------------------ <br /> ------------ ----- - -------- - <br /> FINAL INSPECTION BY:....C:/...... ---,_/-'A--------------------------- Date_----------------------f---- ------- --- --G----- <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 /> ES-9-2m 145445 A7WOOD 12.54 <br />