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APPLICATION FOR SANITATION PERMIT Permit No. .-'7 •____ <br /> I <br /> (Complete in Duplicate) <br /> s l d�z�J c f.til£ Date issued � ------`S ---- <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 rdinance No. 549 <br /> JOB ADDRESS AND LQ <br /> C TION_, <br /> Owners Name-------- <br /> Address------•-------- ---�- /? _----- <br /> ---- <br /> -•---------------------- -------------------------------------- -. Phone.--..------- <br /> --•---•------------•--•-----•-----•---.--- ---------------------- <br /> - <br /> __. <br /> Contractor's Name... ... _ ;�- ft ------ � � --. J`e•��� <br /> - ------------ Phone__.-.--•--•------•---- Y. <br /> Installation will serve: Residence Apartment House ❑ Commercial El Trailer Court E] Motel E] Other- ------------ <br /> ❑ <br /> Number of living units: _-f--- Number of bedrooms -- .- Number of baths ---Z Lot size <br /> E Water Supply: Public system -�--�-�2-�---------`---------•- <br /> PP Y� y Community system ,�rivate ❑ Depth to Water Table ft. <br /> 1 Character of soil to a depth of 3 feet: Sand C3 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8--Hardpan- <br /> Previous Application Made: Yes [) No P New Construction: Yes &-No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T k: Distance from nearest well_ . ---_Distance from foundation-- --_ <br /> No. of compartments-- -�------------------Size-,.� 7� ff`` - -- ---- <br /> Disposal <br /> Liquid depth.- --------- <br /> --- <br /> pisposal Field: Distance from nearest well_ 'Distance from foundati <br /> lie.-_-- Distance to nearest lot line.-�47- t <br /> Number of lines------- ---_--j--- _----_- Length of each line--­f---.r,5� <br /> Type of filter material- <br /> �„_ - --------------------Width of french-_.--:��----- - - <br /> -�-- --- - _Depth of filter material------/f-------•_-Total length_----_--'•�`--•__-_________ _ <br /> Seepage Pit: Distance to neatest well_- - " ---••,' <br /> ?Z -'---Distance from foun tion_- - .�_1-- ----_ <br /> � v Dj"A1.4, to nearest lot lin -. -------- <br /> -------Number of pits..-..-- _-- Lining material s- A'— ize: Diameter--.. - _----- <br /> Depth-.--�----------------- <br /> Cesspool: Distance from.nearest well_------__:-_--Distance from foundation.__---__----------.Lining material-_-------------------- <br /> ❑ Size: piameter------ ---- - -- <br /> ----- Depth--------------------------------- Liquid Capacity ale. <br /> Privy: Distance from nearest well------------------- - <br /> --------------------- -----Distance from nearest building ' <br /> ------------•---•--------- <br /> El Distance to nearest lot fine-_. --.--_--_ - <br /> ----•------------------------------------------ <br /> Remodeling and/or repairing (describe):--_--. �.� --_: ' <br /> ---------------==-- <br /> ---- ------- <br /> . ` <br /> --=- <br /> ----------------- -------- <br /> I hereby certify that I have 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)........ `'-+.- '- •• <br /> - Wiz.---- <br /> ------------------------------ <br /> BY� �� �,•�'/��--- J------------ Contractor) } <br /> {Title) <br /> {Plot plan, showing size of tot, !o ion of system in relation to wells, buildings, etc., can be placed on reverse e). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B<....... <br /> ------ - <br /> - ATE--�:-----•------•------- <br /> --------------- <br /> --------------------------------------- � <br /> REVIEWED BY------------ - - - - _ . <br /> - ---- ------ <br /> --- - •----------------------- ----------------------------------------------------- DATE-- <br /> BUILDING BUILDING PERMIT ISSUED----- �--K---------------------------•---------•--------- <br /> ------------------ - ----- -------------- DATE------¢r�- <br /> - ------------------------- <br /> Aiterations and/or recommendations:---------------------------- 0 -------.------------------- <br /> ------------------------------------------- -------•------- --------•--------- <br /> = ------•- <br /> / ------------------- ---- - <br /> --- -- ----------��r --------- ------J----- -------- --.tl�- -._ ------ --- ` <br /> •----------------• -------------------- <br /> ----------- ----- - --- �---- ----- . ---------- ---------- ---- <br /> i <br /> FINAL INSPECTION BY:.-------. ---------------- Date----------- --� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> S}ock+on, California 814 North "C" Street <br /> Lodi, California Manteca, California Tracy, California <br /> 1n9446 nrw000 12-54 <br />