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APPLICATION FOR SANITATION PERMIT Permit No. . <br /> (Complete in Duplicate) <br /> Date Issued __... ..J.r._��5�-•3 <br /> Application 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_.&A•- 1:rd1__. _____..__ <br /> Owner's Name--------------------------------- (c —;a---------------------------- -------------------------------------------- Phone--A.. �'�...7V <br /> Address_ i 'Y.r` 'f�- '�-#� ` °a""r--/i?. ,..A ..-................................ <br /> IV <br /> Contractor's Name------------------------------------ jem."14611 +�--- ........--------------------------------------------------- Phone--1?_'1Rj6_Q-'7-------- <br /> Installation will serve: Residence [If Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ q .. <br /> Number of living units: ---/__ Number of bedrooms ..I_-- Number of baths j-_-_ Lot size --- ----------------- <br /> Water Supply: Public system Community system PrivatBDepth to Water Table __..._._ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobejK Hardpan ❑ <br /> Previous Application Made: Yes ❑ No)?�_. New Construction: Yes A& 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.-2.4 ..01 Distance from foundation..,/ -------Material 9'1_.*—_Y'$_1-_-s: ,----------------- <br /> No. of comp3ctments- -_ _--_-Sizel`�f_�� -`Liquid depth .$73._... .._Capacity-_'�as��: <br /> Disposal Field: Distance from nearest well ) �,f7.Distance from foundation-_—/ ..........Distance to nearest lot line 47_77.. <br /> ' Number of lines__.....-.-- -Length of each line.... --------------Width of trerch A1/"------- --------- <br /> - Type of filter material..it"llA-----_Depth of filter material....19-'------------Total length,,4/a.IST-__________________________ <br /> Seepage Pity Distance to nearest well---------------- _-__Distance from foundation--------------------Distance to nearest:lot line_-.'__-_-_-_--_._. <br /> ❑ Number of pits----------------------Lining material_------------..-----.Size: Diameter-----__-.----__------DApth-.------------._:.----_-----_---- <br /> Cesspool: Distance from nearest well----------.------Distance from foundation_-----------------Lining material_____---__-_-_----__-__-_---.--_--_. <br /> ❑ Size: Diameter-------------------------------------Depth--------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well -----------------_---_.-----.-_:_-_Distance from nearest building- -- -------...._..:-__..__---.-..... <br /> ❑ Distance to nearest lot line------------ ----------------- "+ <br /> -- ------------- ----- <br /> Remodeling and/or repairing (describe) ------------------------------------------------------------------------------•-....._. ..._----------•-•--........ <br /> --------•----•---------••------------••-----------•-------------------------------------------•-------•-••-----•--•------------------------------•-------•--------------------•--------•-------------.........---------­ <br /> ---------------------------------------------- <br /> ---------- --------•----------------------------­-----------•-•--•--•---------------------------------------•--•-------------•••-------------------•--......------••-•-------•--------------------•------- ----•--•------ <br /> -----------------------------------•--------------------------------- -------------- -------------------•-------------------•---------------------------•--•----------- ---------- -------•-•-----•------•-----•----- <br /> I here�y that I have pared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I ws,�an rules d regu tions of the San Joaquin Local Health District. <br /> ----- � -----------------------•-•------•-•- . •••-- --- Contractor <br /> (Signed) �• ----- ��,,� ) <br /> By:............................................................... <br /> (Title) i.t�s. l <br /> (Plot plan, showing size of lot, location of syst in relation tow s, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. �--' DATE__-___ . _. _ <br /> REVIEWEDBY- --------------------------------- ---------------- - --------._.._..--- DATE <br /> BUILDINGPERMIT ISSUED------------------------------------------ ------•••------•---•-----------------------------------•-_. DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:_.____ _ _ ________ ________.__..__ .._. . --------_ -------------- <br /> ---------------------- --------------------------------------- ...... ------ <br /> . - l� �.,49 ,� <br /> FINAL INSPECTION BY--------------- --- _- _- Date......-"'T.. .... . ___-_. --........ <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 /> ES-9-2M 10-52 Revised W-2100 <br />