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i <br /> APPLICATION FOR SANITATION PERMIT Permit No. JQ_.2.fr-......... <br /> (Complete in Duplicate) Date Issued 1117I-:Y__._ <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 ' compliance w' h County Ordinance No. 549. 2 `t`8�p(e�- Zy <br /> JOB ADD .ESS AND AT N Q P`• <br /> ------------------------------------- <br /> s <br /> Owner's Name -------•- --- <br /> - ---------- --- ---- --------------- ------ ----------------- Phone <br /> Address---- --- -`----- l <br /> Contractor's Name-------------- -- _-- ---------------------------- ------------------- ----------------------------------------­_------------- Phone---------------------------------- <br /> Installation <br /> --------------- •---------- <br /> Installation��will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑I ofel ❑ ' Other ❑ <br /> Ili <br /> Number of living units: ____'_ Number of bedrooms ___Number of baths ._-1--- Lot size _!9—ft.ej---------------_------•- <br /> Water Supply: Public system Community system ❑ Private [Depth to Water Table i <br /> Character 9f soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam;V Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Aplplication Made: Yes ❑ No New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: " <br /> (No�sepfic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well4_6_D-tDistance fro foundat�- _ 0________ -Ma-�al _ _a__p__a__c__i_t_y______ <br /> - C __ ----------- <br /> No. of compartments-.-.-._. ____.___Size... Liquid depth__-_-_-- e <br /> Disposal Field: Distance from nearest well.190_"li Distance from foundation___/_&_.......Distance to nearest lot lime/��Z_��-5 <br /> Number of lines------- :. _J.-..._Length'of each line------ N Width of french___-__2=-4________________ <br /> Type of filter material____ � th of filter material......... length_______1G ______________________ <br /> Seepage Pi : Distance to nearest well----------____________Distance from foundation--------------------Distance to nearest lot line___-_-___-_______ <br /> ❑ Number of pits---------------- - ---Lining material---------------------_.Size: Diameter.----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....._..............Lining material---------------------------------------- <br /> Size: <br /> _ _-________-_______---______ <br /> ` Size: Diameter-------------- -----------------------Deth-------------_-------------- ------.-- - - -----Liquid Capacity gals. <br /> Privy: Distance from nearest well------------------_----------------------------._Distance from nearest building------_-_____-_______________--_-____-___. <br /> ❑ Distance to nearest lot line ------------------ <br /> Remodelingand/or repairing fdescribe):--------------------- ------•------------------•-----•-----------------------------------------------•-------------------------------------- ------ <br /> ---------------- A-------_----------- <br /> 11 <br /> -------------------------- <br /> -------------------11-------------------------------------------------•------------------------------------------------------------------------------------------------ •------------------------------•--------------------- <br /> --------- -----------•------------------------------------------------------------------------------------------------------------------------- -------•--------------------------------------------- <br /> 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,11 Sta �ws, nd rule nd , gul�of the an Joaquin Local Health District. <br /> (Signed ---- --------_----------- •---- -- ---------- - -------------- ------ <br /> ------- -- -------•- .-•------..------ ---- (Owner and/or Contractor <br /> B '•1•-- ----•-------------------------------------- --•--- Title <br /> (Plot plan, slhowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> SIU <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------- DATE------------- <br /> REVIEWED�IBY DATE j_)-;�._' -g- ---------- <br /> BUILDING�pERMIT ISSI.IED------------------------------------------------- -`-- ---�-- �--- •------------ DATE--------- -----------• -•--------- �------- ------------- •- <br /> Alterations,apnd/or recommendations:-- - ------ --- ------------ ----------- '-------------------------------------------•-••---------•---•-•--------•-•------------•------------------- <br /> ----•---------•u4 -------•------- - -------------•-•-------------------------------------------- <br /> 1111 <br /> (i <br /> .1lli <br /> ------- ------- - _------------------------- ------------------------------------------------ ---------- --------••-------- ------------------------••------- <br /> - ------- ----------- --- <br /> FINAL I SPECTION BY: Date <br /> ---------------------------- <br /> SAN <br /> .-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 S0.1h " <br /> American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> ,ii, <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> it <br /> ES-'9 145445 ATWDDD <br />