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tom' <br /> APPLICATION FOR SANITATION PERMIT Permit No. -. <br /> (Complete in Duplicate) <br /> Date Issued -- _ <br /> Applica+ion is hereby made-fo"fke 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 o. 54.1, <br /> -4 <br /> JOB ADDRESS AND LOCATIO <br /> ------------------ <br /> ----------I--------------------------- ------------------------- <br /> Owner's Name--------x14 � = = �!z-a_.etc! <br /> - <br /> - <br /> =� <br /> r------------ <br /> - <br /> Phone -------------- <br /> -------------------------------- <br /> Address------- <br /> Contractor's Name-----i 2 <br /> ----------------------------------------- -------­--- Phone-/7-", 1X7,&4_ <br /> Installation will serve: i ResidenceAl Apartment House <br /> ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living -units: _- --- Number of bedrooms Number of baths ---J- Lot size ------_ es$ <br /> ,- <br /> ---------------- <br /> Water Su I . Public sys+em-❑ ;':Communit system --`----`- <br /> PP Y' Y Y ❑ Private'[p Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla <br /> Previous Application Made Yes'❑ Noa New Construction: Yes [I No Y El Adobe®, Hardpan ❑ <br /> TYPE OF INSTALLATION. AND SPECIFICATIONS: s 1. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sepfiic Tank: ili�ka'nce from nearest well __-.----Distance from foundation-------------- <br /> Material ----------=--------- <br /> ❑ Ni of.compartments ----=---Size- -----Li Liquid de th-- <br /> q p ---------Capacity----------------- <br /> Disposal Field: Distance from nearest well-_.- - -.._.Distance from foundation_-___ <br /> r <br /> _�.----.Distance to nearest lot line----��-- <br /> Number of lines--------1 Length of each line---____..__ �__`_____-Width of trench-_---- ?CI_--. <br /> Type or filter material-,/� � Depth of filter material /.! <br /> a,. --------Total length--------_ _ / <br /> Seepage Pit: Distance to nearest well_: ( --------Distance from-foundation_•--_. s?.-.Distance to nearest lot line-_.4'`'__�_ <br /> Number of pits---- -----� Linin material._L` cuDiameter--...--? �� -r, <br /> Sze: -------Depth--- <br /> Cess ool: ,, _ ----------- ----- <br /> p Distance from nearest well----- _-- --_-Distance from foundation. <br /> ----------------- material____________________.__ <br /> ❑ Size: Diameter--------''------------------------------Depth_----------------- - <br /> ----------------' ---- <br /> �iquicl Capacity------------- <br /> Privy:.' <br /> -- gals. <br /> Pr:vY: Distance from-nearest well--_--.---_-.- -___._ F <br /> ---_--T------ --------Distance from nearest building ' <br /> El Distance to nearest lot liner------. __..,e-------__ ----- - ----------- ----------- <br /> = - =- <br /> . _ <br /> Remodeling and/or repairing(describe]:__:. - = - <br /> ----------• ------ I . <br /> I ,. .a <br /> ------------------•--------=•---=•---------------#----' -.--. <br /> = --------•----------•------•-------=• •------- <br /> --------•------------------------- <br /> ------------ <br /> -•------------------•------------------------------------•-------- --------------------------------- <br /> --------------------------: <br /> a that I have prepared this application and that the work will be done,in accordance with San Joaquin County <br /> ordinances, St to la sand rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------E <br /> . <br /> ---- - --fi --------------------------'-- -- -------- - er and/or 'ConB /! tract- ----=- -- tom'• 'ZP _------------------------ Title------- or'w <br /> (Plot plan, shng Z. of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - <br /> s ,. <br /> f FOR DEPARTMENT USE ONLY , <br /> APPLICATION ACCEPTED BY----------------------------------- -------- _ <br /> REVIEWED BY '' .. := DATE_. -,fS. <br /> ----- ----------------------- '- - - --- DATE-------------------- ......------ - <br /> Bl11LDING PERMIT I$SUED-----=----=--'--------_ <br /> ------------------------- <br /> =-------------------I---------------------------------- DATE ---- - <br /> Alterations and/or recommendations:------------------- -------------------------- <br /> ---- -------------- <br /> ---------------- ----------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------­­ ---- - <br /> ---------------------------- <br /> ------------------------------------------------------------------ ------- <br /> ----------------------- <br /> --------------- -------------------------------------- <br /> } ----------------------------------------------- <br /> FINAL INSPECTION BY: -----------. <br /> -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 132 5yeemore Street <br /> Stockton, North "C" Sfreet <br /> ock}on, California Lodi, California Manteca, California <br /> Tracy, California <br /> ES-4-2M ; Revised W-210o <br />