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rte` \j <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued .-___ __3, <br /> Aplica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION______._-5_,57...Z/.- ---- ------ -- --------------------------------------- <br /> Owner's Name-.......:5------::.v..................... ------ - ------- ---------- -- ------------- Phon e------------------------------------ <br /> -- -- -- ------------------------------------------------------------------------------------- <br /> /7 <br /> Contractor's -------------------------------------------------- Phone/,;&..1e--fd120_7__ <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel 0 Other [:] <br /> Number of living units: Number of bedrooms -;?—Number of baths f------ Lot size __-_-.- ._____ _1._ .7................ <br /> Water Supply: Public system Community system E] private [:] Depth to Water Table .-5 ff. <br /> Character of soil to a depth of 3 feet: Sand F1 Gravel El Sandy Loam E] Clay Loam E] Clay E] Adobe ._Hardpan E] <br /> Previous Application Made: Yes E] No aj-- New Construction: Yes, No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: - -&--Distance from nearest well________________Distance from foundation--------------------Material------------------------------------------------- <br /> Eli'4,L,­�of compartments_____________- -----------Size------------------------------..Liquid depth ----------- ---- --------Capacity----------------------- <br /> Disposal Field: Distance from nearest we1I__/t101.-?-.-.,Xisfance from founclafion,___� Distance to nearest lot line_--- 0. <br /> r er <br /> Number 01 iines------ Lengfn of each line----_ Width of frenck-- ----- --------- ------------- <br /> /_-ir, -------- ;r--------- <br /> Type of Filter material-13L Depth of filter material-/9-- ----- Total length--_----NO-----_____-------------- <br /> it -z&/ <br /> Seepage Pit: Distance to nearest well_/4,/4r2.i,,__Distance from foupdation___!�-e.------Distance to nearest lot line_.._ <br /> Number of pits._.._./.............Lining Lining materiali��- ------�. ize: Diamefer___.:5��__1pe__Depth.,15�Z-57" <br /> .... - - ------------------ <br /> Cesspool: Distance from nearest well---- --------Distance from foundation--------------------Lining material-_--_---.--.--..__-_.____-___-----__ \{ <br /> ❑ <br /> aterial------------------------------------ <br /> El Size: Diameter-------- -----------------------------Depth-------------------------------------------------.--Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building._______-----.._---.-----____-__.___-_.._. -f� <br /> El Distance to nearest lot line-------- - ---------- ------ --- - -------- - -------------------------------- ---------------------------------- --------------------------- <br /> Remodeling and/or. repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------- <br /> -------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I-­-------------------------- <br /> -----------------------------------------------------------.......-­------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby at I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St, <br /> and rules and regulations of the San Joaquin Local Health District. <br /> y <br /> (Signed 7e------- --------------- ------.---- (Oypr and/or Contract <br /> Y. ----- ------- -- -_ - --- - --- --------------------------------(Title)----- --------------------------------------- <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 /> APPLICATION ACCEPTED BY-------------- ------------- ------------------------------------------- DATE------— ------------------------------------------------ <br /> REVIEWEDBY--------•------------------------ ------ - -------- ------ a- ----------- ----------- ---- - ------------- DATE----------------- -------------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------- - ----------------------------------------- --------- DATE.----------------- <br /> --s- ---------------------------------- <br /> Alterations and/or recommendations--------------------------- -- ---- - ---------------------------------------------------------------------------I\_ _ <br /> 4XI----------------------- <br /> --------------------- --------- -- --------- ----------62----- --------------------------------------------------------------------------------------------- <br /> -------------------------------- -- -----r,------ ------- ------ - -- --------------------------------------------------------- ----------------------------------•------------------- <br /> ----------------­­---------------- ------- ---------------- ---------- --- ---------- - ------ -- <br /> "l-------------------------------------- -------------------------------------------------------------------------- <br /> ----------------------------------------------------------- ----------------------------- ------------------------------------------------------------------------------------------------.------------------ <br /> ------------- <br /> FINAL INSPECTION BY:..�. �--------------------_--------- Date. --------- ........ .7 -------------------------------------------- <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 /> ES­9—ZM Ia54a6 A7W000 12.54 <br />