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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued _____ __1�.� <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 compliance with County Ordinance No. 549. t <br /> JOB ADDRESS AND L CATIO•.N---- 3------ <br /> � V/G----- -----_:IA_-Dc_k4Q--rj------ <br /> ---------------------------- <br /> Owner's Name___CTID fl- "'R..... 7J0 �.----- Phonf --------------------------- <br /> Address---------------------- <br /> -----Address___-_•---------------- t <br /> Contractor's Name_ r-Kr{F',}_._ trz�_.i� c G --" ,- .ge-�aaa;� . qu rs'/ O n ly -.---Phone-- -- -A?-77-- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___f__ Number of bedrooms _.Z._ Number of baths/_____ Lot size __/---9-a-'w__' ---,2:, - .-- -- <br /> Water Supply: Public system ❑ Community system ❑ Private [R'/Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand V Gravel ElSandy Loam ❑ Clay Loam F] Clay E] Adobe ' Hardpan ❑ <br /> Previous Application Made: Yes ElNoNew Construction: Yes o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r <br /> Septic T Distance from nearest well-6-p-_____Distance from foundation_ ` � 7 <br /> i> it Mafienal ------ <br /> ---- -------- <br /> iJo. of compartments ...._...17-0------- Size-J_ __ _n,�--._' Liquid depth_.�_`r-._--_-_-Capacity__�'4y-__ C <br /> r. L ,1" C/-Pa P <br /> Disposal Field: Distance from near�jst well-5 ._____Distance from foundation___ v'`.__.Distance to nearest lot line--------gip-`� <br /> Number of lines_____-!________._F�fp Length of each line__/,./1_'___. .____.-.Width of trench----- �"_________________ <br /> Type of filter maferial._._(.h-�._f�S_.__ _Depth of filter material--------- _�....__._Total length.__f�r-�_`_________________________ <br /> Seepage Pit: 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: Diameter------- ------------------------------Depth----------------------------- ------- ----- -.-----Liquid Capacity-.-------------------- -gals. \ <br /> y Privy: Distance from nearest well_____________________________________-__-._.._Distance from nearest building-----_________.__-_____________-_-___.___. <br /> ❑ Distance to nearest lot line---------------------- -- ---- <br /> Remodeling <br /> --Remodeling and/or repairing (describe)------ - ------------------------------ -----------•-------------------•-------------•----------------••----------------------------------- <br /> -----------------------------------------------------------------------•-----------------------•-----------------••-------------------------------------------------------------.----•----•-----------•------------- ------- <br /> I her ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance Ste laws, a regulations of the San Joaquin Local Health District. <br /> (Signed) --- ----------- �----------- ----------- -------------------------------------------- : Contractor) <br /> By:------ ----•---- •----------------------------------------------- r- ------{Title)-- - `---------------........ <br /> (Plot plan, showing size of lot, location of system in r Iation to wells, bui Ings, etc., can be placed on reverse side). Cl- <br /> FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ----- <br /> DATE_. --------------------- <br /> REVIEWED <br /> _________________ _ <br /> REVIEWED BY---------------------------- _ DATE_-!�--- -------------------------------------•------ <br /> BUILDING PERMIT ISSUED---------- DATE---------9..tx______________________ <br /> Alterations and/or recommendations--------------- -- - -- --------------------• -----••---------------------- --------------------------------- 1'- <br /> ----------------------------• -----•----------------•--------------•----------------------------------------- -------------------------------------------------•--•---------------------------------------------------- ------ <br /> ---------I ---------------------------------------------------- ------------------------------------------------------ ------------------------------------------------•--------•---------- ---------------------------- <br /> ----------------­------------------ ------- ---------------------------------------------------------------------------------------------------- ------------------------------- --------------------------------- <br /> ---------------------------------- <br /> FINAL INSPECTION BY:.----- Date ------------ <br /> SAN <br /> - `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 145ga6 aT wpOo 12-54 <br />