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APPLICATION FOR SANITATION PERMIT Permit No. ____6_U_7._U__ <br /> y� <br /> (Complete in Duplicate) ff i <br /> Date Issued ._..�..__.��� <br /> Applica-l-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 LOCATION ���-.5 Y ------------------------------------ <br /> Owner's Name......... ----------------=---------C.Q--J_e----k-.1—. `----------------------------------------------------------- Phone------------------------- <br /> Address--•---;7Z& ------------------------------------------------- -•--•-- •-----------•----------------- ------F------------------------------------------------------------------- <br /> Contractor's Name---- ----- -I C' -••-------- Phone----••------•---------------------- t <br /> Installation will serve: Residence A artment House Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> p ❑ ❑ <br /> Number of living units: _./___ Number of bedrooms ___Number of baths 1_._. Lot size --- 7_ a�-r._.._ 4-P-_o <br /> Water Supply: Public system ❑ Community system ❑ ,Private to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cay Loam ❑ Clay ❑ Adobe[3—Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [�J­ New Construction: Yes Wa—No ❑ <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---V _ -.Distance from foundation-_.-.--- _----.Material.........�.__ �" '� <br /> ----------------------------- <br /> E' No. of compartments----� --s ...... .1 ----d--- _C.."_Liquid depth.---�(----- ---------Capacity-_-,94--d-------- <br /> Disposal Field: Distance from nearest well-__61 Distance from foundation-----Z__fJ.._r.Distance to nearest lot iine.�52_-_`__. <br /> Number of lines---------------- Length of each line------- .-1 -.--.-.Width of trench------;�__/._....--__.-...--- <br /> Type of filter material -_-./.-__,.f----�A3 Depfh of filter material-------!_.ie-_---.__-Total length---------- --------------------- <br /> Seepage Pit: Distance to nearest well--- Distance fr m foundation _ __Distance to nearest lot line-_ld....... <br /> ��• Number of pits....___-.l----------Lining material... Size: Diameter-.Z.1.,_.-_ Depth- �_.---._.--______________ <br /> Cesspool: Distance from nearest well------- -------Distance from foundation-.-.---- --------Lining material ---._----------------------I_----_-_-. <br /> ❑ Size: Diameter----- --------------------------------Depth---- --------------------*-- ------------ --------Liquid Capacity_------•---•---------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ <br /> T-1 Distance to nearest lot line---------------- - ------------- -----------------•---------••------------••-------------••---------•-------- <br /> ------------------------------- <br /> Remodeling and/or repairing (describe:- G.1l>Gi zs -------------•--•----•----------------------- <br /> ----------------- ------••--------------------------------------- •--------•-----------•---------.------..----- ------------------- ------------------------------•---------------------------r------ <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 1 and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) 1 -------------------- <br /> ------- <br /> and/or Contractor <br /> - -------- -------- ---------- <br /> =(Plo : ------- --- --- --- ---- --- --------- ----------(Title)---sy _. er <br /> = ----------------------------------- <br /> (Plot <br /> t plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT U_SE ONLY <br /> APPLICATION ACCEPTED BY---- -- --- <br /> DATE <br /> REVIEWED BY------ -------------------------- ---------- ---- _ - DATE <br /> BUILDING PERMIT ISSUED------------ ------- ------- '---------------------------------------------------- DATE--------------------- --- �- ----------- <br /> --- ------------- <br /> Alterations and/or recommendations---------------- ---- - -- - -----------------------------------------•-------•--•----••---------------•-•- ------- ------------------------ <br /> ----------- - r = - --- --------------------------------------------------------------------------------•-- <br /> �� .- . --- - -• ----- ---------- <br /> 2��5 <br /> FINAL INSPECTION BY:.--- ------ Date--- __—A--- J-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Stree+ <br /> Stockton, California Lodi, California Manteca, California Tracy,-California <br /> �$ 145446 AT-011D 1 - <br />