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1APPLICATION FOR SANITATION PERMIT Permit No. 4__47.5� <br /> [Complete in Duplicate] qq p <br /> Date Issued,_,4 <br /> Applica4ion is hereby made to the San Joaquin Local Health District for a permit to co struct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549V . co <br /> M I � <br /> JOB ADDRESS AND LOCATI -- ----- P° v a(,� i <br /> Y �.�, - JIB_ Phone--- t?_P_ ' <br /> k Owner's Name____--_ fir____ __ <br /> Address----•------------- ' •__ _f/ f`_. = y <br /> t <br /> Contractor's Name--------------------------------- - ----- -------- C'------------------•--__------------ --------------__ Phone-.- <br /> Installation <br /> honeInstallation will serve: -Residence ❑ Apartment House ❑ Commercial oq4railer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms ________ Number of baths _ Lot size _ �_ _ -.1 ----------------__ <br /> r Water Supply: Public'system Community system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Claoam E] lay Adobe Hardpan E]Previous Application Made: Yes ❑ : No New Construction: Yes E] No or <br /> ; <br /> TYPE OF,:INSTALLATION AND SPEC IFICATIONS:r,c"No, <br /> JJ <br /> septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 <br /> kl Distance from nearest well_________________Distance from foundation________------____Material____.___�__.__-____--___._____-_-_.._________-. <br /> No. of compartments-----------=-------- -----Size--------------------------------Liquid depth------------ ------------ Capacity----------------------!Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number of linesDistance from nearest well__-------------#Length of each line------------------------------Width of french----------------___.._______________ -, <br /> Type of filter ma.terial-------------------------Deterial-----------------------Total length--=-----_- -__-- - ------------ <br /> Seepage Pit: Distance to nearest well- Dun tron__ Dist nce to nearest lot ine____ _________ <br /> - -- � <br /> Number of pits__.____________ Lining ma ____. ize: Diameter__ ------- ____.Depth-A.-144-`______________ <br /> Cesspool: Distance from nearest well--------------- Do dation__.----------------Lining material-------------------------------------- <br /> Size: <br /> ____.___---- _.________-___. <br /> ❑ Size: Diameter -- - ------------------------------D -----------------------------------Liquid Capacity----------------------=="`---gals. <br /> I <br /> Privy: Distance from nearest yell-------- <br /> --------?--------------------------------Distance from nearest-building ______--___.-_______.________..______.- <br /> Distance-to nearest lot line------------- ----- ------ -----=---------------------------------- ------------ <br /> Ell Q i Y +, w, <br /> Rem eling and/or repairing (descrii�e):__ •- �, <br /> x <br /> ---- <br /> _° 9 i -------------------- <br /> --- --- <br /> -s---__-_ -- --r--- <br /> --4- <br /> k . <br /> ---- '.-- <br /> ---------------- ------­-- ----- <br /> ---- <br /> --------------- ------------ = <br /> s I hereby certify that I have prepared phis application and that the work will be one-in accordance with San Joaquin County M <br /> ordinances, S`}me-laws; rules and regulafi ns an J in Lacal Health istrict.. <br /> ` + _ <br /> S <br /> a <br /> Si ned 'f'f'/5 ------------. <br /> _ r . <br /> �9 ) '-`=- - ---- - - _ ------- ----- ------- ontractor) <br /> -- <br /> BY: - = LTitle----- �J'�� <br /> (Plot pian, showing size of lot, location of system in elation wells, buildings, a ., can be placed on reverse side). t <br /> - FOR DEPARTMENT USE ONLY y F <br /> ACCEi'TED BY - - -- - ----- ------ -- ::. :;.:---�;-.----- :------- DATE --/CEJ,------------------------- <br /> APPLICATION <br /> REVIEWEDBY------------------------' --- - --------- ------------------------------------- ---------•-------------------- DATE-------- --- -----"---� = a <br /> BUILDING PERMIT ISSUED'---"--------------- --------------------------------------•--------------------------------------- DATE <br /> Alterations and/or recommendations---------------------------------------- -------------------------------------------•------------•--•----------------•---------•--- <br /> -=-----id-----------------------------------------------•--------------------------------------------._-..------------;--•----_.----•--....-------------------------- <br /> --------- ----------------------------- ------ .----------------------------------- ---- � i <br /> -----•------------------------------•--•---------------,--- ----------------•------------------------------ <br /> t f <br /> FINAL INSPECTION BY:------- - = Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak.Street 132 Sycamore Street 814 North "C" Street <br /> N` Stockton, California Lodi, California Manteca, California Tracy, California_ <br /> s <br /> ES-4=2M Revised W-2160 <br />