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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued --- <br /> Appiica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the woA herein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> --- ---- <br /> JOB ADDRESS At��ILOCATION.... ---- --------------------- <br /> Owner's <br /> Name- -- - ----- -- ------------ -- ------------------------------------------------- ---------------------------- -- Phone-------------- , <br /> Address- <br /> hone-------------- <br /> Address_ ------- - ---- ------ !---------------------------------------------------- <br /> Contractor's Name.........z- --------­........ ----------------------------------------------•--- <br /> ---------------------------------------------:--------------------------------------- ------- Phone----------------------------------- <br /> Installation will serve: Residen Apartment House El Commercial [I Trailer Court E] Motel F <br /> Other E3 <br /> Number of living units: -1---- Number of bedrooms __/--- Number of baths -0- Lot'size <br /> , --f ----------- <br /> Water Supply: Public system El Community system E] Private K Depth to Wate r Table --- A> <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam I] Clay El Adobe Hardpan ❑ <br /> Previous Application Made: Yes F-1 No � New Construction: Yes No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is ayailable'lwithin 200 feet.) <br /> Septic Tank: Distance from nearest we1I....,<0___Disfance from foundation__(t -.Material <br /> ------------------ - -------- <br /> Y <br /> No. of compartments-... - ,?--.-----------Size--- depth----------'# _ Capacity----I-/-a-C-4 <br /> Disposal Field: Distance from nearest --Distance from foundation-----t!��Distance to nearest lot line 15`4 <br /> r ---------------- <br /> Number 01 lines___._______...I-----------------Length of each line---------I---1__6______.Widfh of french......2,_,Jd�--.-- <br /> Type of fitter material.........................Depth of filter material.-!............ --------Total length------- <br /> SgWa2e Pit: Distance to nes;41-f- e�11 _16'&_" ' isf�n e fi�orri fou afi n, isfa c to nealrsf�kf ]Yipe---- <br /> sf" ' f�'m <br /> isfa c <br /> a --it <br /> Number of s__ _`x.,!,;Linii ncj material- D4amef ---�1_X--- --- <br /> Cesspool: Distance <br /> nearest weld____-------------Distance from foundation------- - - --------Lining material------------ <br /> u <br /> Size: Diameter.-------. . ------ ------------:------Depth------------- --------------------------------------L u;d ---- <br /> �Ca ai�fy_ - - <br /> Privy- Distance from nearest well._.._. ________ _____________=------Distance from nearest building______. 0-.`- �- - <br /> Distance <br /> uilding------- <br /> Distance to nearest lot line-------- ------------------- <br /> ------------- <br /> Remodelina and/or repairing {describe}:.......11:7�5 )l <br /> - -- - ------- <br /> -- ---------- <br /> -4. ............. ......, <br /> -- ---- - ----------- -------- <br /> -- ----�;_ ---------- 114 <br /> - --------- <br /> ­------------------------------------- - --------- - <br /> ------ . ... .. <br /> ....................----------------------------------------------------------------------(7- --- <br /> -- ---- <br /> I hereby certify that 14-a-ve-prepared this' application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed). A__ -- --------- ----I------------ ---------------------------------------------------------------- -------(Owner and/or Contractor) <br /> ..�7---------P_ -t- - <br /> -- <br /> By:------------------ ;? .------ ------------------------------I-----------------------------------------------(Tif le)----------------------- -------------------------- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- ----------------------------------------------- --------- <br /> -------------------------------- DATE----------------•------------------------- ---------- <br /> REVIEWED BY------------------- ------------------------------------------ A DATE--------------- 1—�� <br /> ....:---- -1------ - - - --------- <br /> BUILDING PERMIT ISSUED------------------------------------ J.�Ple ----------------------- DATE----------------------- <br /> Alterations and/or recommendations:----- ......................T4 --------------- <br /> --------------­­ -------------------------------------------------------------------------------7*----------------------------- <br /> ---------------------------------------------------------------------------------------- ---------------------------------------------------- ---------------------------------------------------------••------------------ <br /> -------•-- <br /> ------------I---­-------------- <br /> ----------I---------------------------------•---------------. ------------- ----- ------------------------------------------------------------------_----------- ------------------------------ <br /> ---------------- 2--------------2-4 <br /> -­ ----- ---------------------- .I - ----- ------------------------ <br /> ----- ------------------------------------------------------------------- ----------------- <br /> - ------------------------------------- ---- - -5 4 <br /> ---------------- ...... ---------- ------- -------------------- --------------------------I ----------------------------------------------------------------- <br /> FINAL INSPECTION BY------------------- ----------------------- ----- - Daf e <br /> -------------------------- <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 545446 ATWCOO --4 <br />