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APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in Duplicate) Date Issued <br />Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br />application is made in compliance with County Ordinance No. 549. <br />JOB ADDRESS AND LOCATION <br />-f- - -------------------- <br />Owner's Name------ -------------------- ------------------------------------------------------------------------------- Phone -------------- : ---------------------- <br />uAddress --------------- a4_9AWW r__ S__( e -------------------------------- ------------------•------------------------------ ------ ——------- --------- <br />Contractor's Name_____ of/_U ----- a✓ t- iiwl ---- ----------------------------------- - ------------ Phone 4k .... ..6 70--v & <br />' Sx-_7 <br />Installation will serve: Residence g -Apartment House [:] Commercial Trailer Court E] Motel E] Other El <br />Number of living units: Number of bedrooms __7,e` Number of baths j---- Lot size -7 -- ---------------- <br />Water Supply: Public system Community system El Private F1 Depth to Water Table -------- ft. <br />Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam E] Clay Ej Adobe 2r -.*Hardpan E] <br />Previous Application Made- Yes E] No �Nw Construction: Yes E] No 0 PHA/VA-. Yes E No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or' cesspool permitted if public sewer is available within 200 feet.) <br />Se&�c Ta k: Distance from nearest well_________________ Distance from foundation -------------------- Material ------------------------------------------------- <br />F19— AO—L.�"A—ef No. of compartments -------------------------- S;ze ---------------------------- ---Liquia depth -------------------------- Capacity ----------------------- <br />ox - e <br />Di ---- A0, <br />sal Id: Distance from nearest well__jjvjK_e ---- Distance from foundation -_40 ---- Distance to nearest lot line/Of --- <br />I <br />(k�5gi[4A?­41 Number of lines -___j------------ - ------------ Length of each line_____ Z -v - ------------- Width of frenich ------ 2-14-1 ................ <br />Type of filter material -------- Depth of filter mat ----Total length ---------------- ------- <br />Seepage Pit: Distance to nearest Distance from foundation_-- ------- Distan"ce to nearest lot line-_`-_ <br />Number of pits----- ----------------Lining 'material --- Ro_cA ------ Size: Diameter -15 --------- Depth ------ A,.,57 ---------------- <br />Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material_______ 11.1 <br />El Size: Diameter -------------------------------------- Depth ---------------------------------------------------- Liquid Capacity ----------------------------gal; <br />Privy: Distance from nearest well ---------------------------------------------- -- Distanc'e from nearest building ----------------------------------- I <br />❑ Distance to nearest lot line------------------------------------- --------------------- -------------------- <br />------------------------------------------ <br />Remodeling and/or repairing (describe) ------------------ ----------------------------------------------------- -------------------- ---------------- I -------------------------------------- <br />--------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- -------------------- I -------------------­ <br />-------------------------------------------- ­­ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br />-------------------------------------------- ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ - -- <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />71- eve, <br />A --- - --- ---- - ----------------------------------------- f0wiveawki&r Contractor) <br />-------- (Title) <br />By: ------------------------ ---------------------------------------------------------------- - -- etc., <br />- - <br />--------------------------------------------------------------- <br />(Plot <br />--- ------ --------------- <br />Ills, buildings etc., can be placed on reverse side). <br />(Plot plan, showing size of lot, location of system in relation 1; W111I.- buildings <br />e" <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY -------- n.k- - Q 1- ---------------- -------------------------------------------------------- DATE------- ------------------------- <br />REVIEWEDBY ----------------------------------------------- _ ---------------------------------------------- ----------------------------- DATE ------------------------------------------------------------ <br />BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------------------ DATE-------- ------------------------------------ ------- _ ------ <br />Alterations and/or recommendations: ------ ---------- -------------------------------------- ----------------------- ------------------------------------------------------- <br />----- -_•------------------------------------0.,-K- ------------------------------------------------------------------------------------------------------------ <br />---- ­ -------- ­ <br />------------------------------------------------------------------------------------- - - ------ - ---------------------------------------------------------------------------------------------------------------------- <br />-------•-------------------------•-•------------- <br />------------------------------------------------ --- ------------------------------------------------- - ------- - - -- ----------------- ----------------------------- -I --------------------------------------------------------------------------------------------------------------------------------------- <br />---- <br />FINAL INSPECT BY:.- Date ----- <br />----------- <br />SAN -------- ------------- <br />JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street <br />Stockton, California <br />ES -9-2K4 Revisea 1.57 FT.CO. <br />300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Lodi, California Manteca, California Tracy, California <br />