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APPLICATION FOR SANITATION PERMIT Permit No. .74-------------- <br /> -1 <br /> (Complete in Duplicate) <br /> Date Issued <br /> 030 —LX <br /> Applica-�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 compliepce with �Cot <br /> my Ordinance No. 549. �t <br /> }JOB ADDRESS AND LOCATION- f (� _ . - <br /> f�� ._--f--� -.- .-- - -- - _ _ <br /> Owners Nam (?-t' ,v� <br /> ] ` e!;a—-- -- .'. Phone <br /> Address ` <br /> Contractor's Name...----.-__ <br /> -- ----- --- -- - --- - - - --------- -------- - ---------- Phone---...------•--------------- ------ <br /> Installation will serve: Residence ❑ Apartmetit House ❑ Commercial . Trailer Court [J Motel ❑ Other ❑ <br /> Number of living units: -------- Number of edrooms -------- Number of baths -_Z- Lot size ..... <br /> Water Supply: Public system ❑ Community ystem ❑ Private-a. Depth to Water Table -40ft. <br /> Character of soil to a depth of 3 feet: Sand E Gravel El'-'Sandy Loam ❑ Clay Loam p Clay [) Adobe Hardpan [ a <br /> Previous Application Made: Yes E❑ No k&- New Construction: Yes 2�_No ❑ <br /> TYPE-OF INSTALLATION WAND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) <br /> ,—Septic Tank: Distance from nearest well-_, Sd-----Distance from <br /> No. of compartments-------- -------------Size-�5--X---jC-----Liquid depth...6-v--------------Capacity-.AtQ <br /> Disposal Field: Distance from nearest well-.-..YC)....Distance from foundation---- - -_.-..Distance to nearest lot line---zo-tr <br /> Number of lines--------____/_- _- ---- <br /> Length of each line------- Width of #ranch.-.- <br /> . .h r ------ <br /> Type of filter material-/ . --.03W -Depth of filter material-._ ptal length--------- - ---� <br /> Seepage Pit: Distance to nearest well../- -__------ <br /> Distance from foundation-------&;3_--_.Distance to nearest lot line-----. 5_-_ <br /> Number of pits------ -------_--.- fining material-.0 e--62----'—§ze: Diameter-------- -_~_Depth......... r--_---- <br /> ' _ <br /> Cesspool; Distance from nearest well-------------- -Distance from foundation.---_-..--..---.---.Lining _ <br /> material--_-.--------_-._.-_----_ <br /> ❑ Size: Diameter-- - ---- -__-Depth-_- Liquid Capacity-------------- - <br /> Prrvy: distance from nearest well _ - .-_ .....Distance from nearest building <br /> ❑ Distance to nearest lot lire--- -------------------------------------- <br /> -------- <br /> Remodeling and/or repairing (describe)--------------- ------- --------------- <br /> ------------------------------­ <br /> ------------------•------•-----•------­-------------- <br /> --------------------------------------------------------------- <br /> hereby certif Aaf I have prepared this a plication and that the work will be done in accordance with San Joaquin County <br /> ordinances, St a S5, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed--------- <br /># ---------- ---------------------- -----•---- ------(Owner and/or Contractor) <br /> BY= - �' - -------- -----(Titlei----- <br /> ot plan, s owi1.ng size of lot, location of system n relation to wells, buildings, etc., can be placed on reverse side). <br /> OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- - , <br /> ------------ ----- DATE------- <br /> REVIEWED BY-------- - ------- ------ --------- - DATE---- <br /> -- ------------------------ <br /> Alterations and/or recommendations:------------------ --: \ <br /> UILDING PERMIT ISSUED DATE , <br /> ------------ ---------------------------------------------------- <br /> ------------------------------------ --------------------------------------- ---------------- -----------------------------------------------------w--------------------K---------------------------------- <br /> ---------------------------------------•-- <br /> - ---- --- --------------------- -- <br /> --------------------------------------- ---------------------------------------------------------------------- <br /> F <br /> ---- - - <br /> F1NAL INSPECTION By:,--, ----------------- 1 <br /> - ----- � Date_�.-�'�----'r`•�-'----------------------------------------------- <br /> SAN J AQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West 01 k Street 132 Sycamore Street 814 Noh "C" Street r <br /> Stockton, California Lodi, Cali ornia Manteca, California Tracy, California <br /> ES-9-2M ig5gq6 ATW boo 12-5q <br /> f <br />