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APPLICATION FOR SANITATION PERMIT <br /> Permit No. i- l_------ <br /> 5,'J✓ I (Complete in Duplicate) <br /> Date issued5--�--- <br /> Application 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. <br /> A' <br /> JOB ADDRESS AND OCATION__________ ____ __ ___ -� �---- ---�- --- ........ <br /> �Q. may, - -------------- - .q <br /> Owners Name.. -- -�-•--C--+--�----- ���', � --- -- Phone-_P �f <br /> 7 . <br /> Address----------•------ `Sj ` r ` �---`�-{°w----------- ------------- -----------------•-----------------•----- p <br /> Contractor's Name S�_,4 Y------ = = ^C' Phone !_..r fa <br /> Installation will serve: Residence,®'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:+__._____ Number of bedrooms -------- <br /> Number of baths -------- Lot size _ ./- d-�x----�� O----- --------------------- <br /> Water Supply: Public system [�'�Community system ❑ Privats❑ Depth to Water Table -f/_Q {t. <br /> Character of soil to a depth of 3 feet: Sand ' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ A obeardpan ❑ <br /> previous Application Made: Yes El No ` New Construction: Yes ❑ No y ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Q»� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic nk: Distance from nearest well-----_..-----------Distan from foundation .__!- - _-_-. ____________________ __ <br /> _______-- <br /> - <br /> _ --00 <br /> ----- <br /> No'. of compartments _A------ .. 3fy� t Capacity--- <br /> - �. ---Li ude , <br /> � <br /> Dis Dial Field: Distance from nearest well-- - ------ <br /> fDistance from foundation-.---.-. -,._.-.-Distance to nearest lot line----- <br /> p / ---- -- <br /> Number of lines-------------------I-----------=--Length`of each line---!40-----------;�__._--------_Width of french-----_ _-��-----------1-------- <br /> Type of filter materiall_ �` a/�------Depth of filter material-___.1_ll-_-_ Total length ---------- <br /> ---:------ <br /> 1 - gyp' s <br /> See pa e Pit: v i Distance to nearest well-._--�---_Distance from fou dation_____ �7__-_.-_.Distant a to nearest lot liX., <br /> e--. ----- <br /> Number of pits.-----f---------------Lining materiaLG'��-- --Size: Diameter------ -----Depth...-02_--_-- <br /> ---------------- <br /> F Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material--------------------------- .----. e <br /> ❑ Size: Diameter-------- ----------Death-------------------•- ------ ----------------------Liquid Capacity-- ---------gals. <br /> Privy: Distance from nearest well.................... ------Distance from nearest building------------------------------ <br /> ------- <br /> - <br /> ❑ Distance to nearest lot line--------------------- --------------------------------------------------------------------------------------------- -------------------- <br /> Remodeling and/or repairing (describe)---------- --------------------------------- -------------------•-------------------------------------------- ------------------------------ <br /> I <br /> _______� <br /> ------------------�•.__-__•-_____•______•_____-_____._. 4 '- -------------­ <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 JoaquiACounty <br /> ordinances, State laws,, hand rules and regulations of the San Joaquin Local Health District, <br /> /� <br /> ----- <br /> (Signedand/or Contractor <br /> )----------- '--- --�-------- �"'.� / <br /> --- -_-------�---p ---------------------------------------------------------------------(Titlel <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 /> ! DATE--------------- <br /> APPLICATION ACCEPTED BY------------------ ---------------------------------}/ S s, . <br /> �,� DATE---------------- ----------------------------------------- <br /> BUILDING <br /> ---- <br /> REVIEWEDBY------------- --------•----------------------------------------- ----- ----- --------------------------------------------- ---- --------------•------------- <br /> BUILDINGPERMIT ISSUED----------------------------- - -- --------------- DATE------------------------------------ ---------------- <br /> Alterations and/or recommendations:------- ---- -------- <br /> -------------•-•------------------------------------------ <br /> -----------------------------------------•---------------------------...-•-----------------------•------------..- <br /> _ <br /> FINAL INSPECTIONBY:_ "' t �� C +" � Date----------------------- f - -------------------------------- <br /> SAN"JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamoro Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> s <br /> E$-9-2M I0-52 Revised W-2100 <br />