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APPLICATION FOR SANITATION PERMIT Permit No.e_-i�!..------ - <br /> � 3 <br /> = . <br /> -� [Complete in Duplicate] <br /> ,._ .. Date Issued _-- -- ---•--- <br /> ApplicaTion"is hereby made`to the San JoaquinyLcal' Health District for a permit to construct and insta12h9work herein described_ <br /> This application is made in compliance with CoOrdinance No. 544. q /I?— <br /> This } <br /> JOB ADDRESS AND LOCATION__________________________. <br /> ----------- <br /> Owner's Name------------------------ aA4__�jL_----•- '�'u'� _ ----------------------------------------------- Phone- �-' <br /> I <br /> j�'] ate.�, -----------•---- - -• ----------------------- <br /> Address <br /> ----•------- ---- -- - - -- <br /> 0 �-b <br /> p (f --------------------------- -- - - -----------.... Phone- --- ---------r -- <br /> Contractor's Name--------------------- ------------------------------------------------------------------------ <br /> - --------••---...--- - � <br /> Trailer Court Motel ❑ Other ❑ � W <br /> Installation will serve: Residence [&/Apartment House ❑ Commercial ❑ ❑ <br /> _ Number of baths ---/__ Lot size ---- 0-r-�--' 4-0-�--------------- I <br /> Number of living units: __I__ Number of bedrooms _ �� `;. <br /> Water Supply: Public system U?"'Community system ❑ Private ❑ Depth to Water Table U ff.-t­ "�Ir <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay E] Adobe,K Hardpan ❑ t <br /> Previous Application Made: Yes ❑ <br /> No)9, New Construction: YesA No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [No septic tank or cesspool permitted if+public sewer is available within 200 feet.] <br /> ---------__.Material_--�l �-- ------------ - <br /> Septic Tank: Distance from nearest wellj�--�_____Distance from foundation � �1-----------•- # <br /> No. of compartments.._ <br /> Size �. "Y-�„�-----Liquid depth---5 -- _Capacity_ Dp 6 <br /> � - _ Distance to nearest lot line.__�6_'__ � <br /> Disposal Field: Distance from nearest well_if '-_Distance from foundation___._._ .__ f <br /> ----- <br /> Len96 of each line____ __ __— Width of french._ _�_--------------------- °y <br /> 1�I Number oY lines------- 9 <br /> J� ---- �� <br /> ii <br /> Type of filter material/�_ ------Depth of filter material__. , ------ Total length------- --- ----------------•----- -- <br /> Seepage Pit: Distance to nearest well_.±l ©_`------Distance fr foundation ---. istggance to nearest lot Iine___.�Q___.._. <br /> Number of its__.__ Linin material ---Size: Diameter--e.3��-------.Depth____ <br /> p I------------ g <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----____.------------Lining material---------------------------------- ` <br /> ----Depth------------- -------------------- = --------Liquid Capacity---------.------------------9als. , <br /> ❑ Size: Diameter. <br /> Privy: --_._Distance from nearest building.__________________.___. <br /> Distance from nearest well-------------------------------------- -- <br /> ------------------ <br /> ❑ - <br /> Distance'to nearest lot line________._________ _ -------------=•-•---------------------------------------------------------------------- <br /> ------------------------------•------- ------------------------- --------------•--------••-----... <br /> Remodeling and/or repairing (describe}_____________�_:_._ •-----••-•------••-------- F' <br /> r <br /> ---•------ -----------------------••-•---------------------- -----------•-••------------------------------- <br /> --------------- -------------------- -------------------------•- <br /> ----------- <br /> -- <br /> ----------------------------------- ------------------------------r-----------------------•-----------•----------------•-------•-----•-------------------------- -------------------------------------------- ----------------- t <br /> 4 <br /> I here er+ify that I have prepared this application and that the work will be done in accordance with San Joaquin County I <br /> w , and ules and regulations of the San Joaquin Local Health District. <br /> ordinances St to las <br /> I <br /> ' [Signed]--- - -------------- Contractor) <br /> - ----- ----t--- - - - - <br /> By:_-_------------------------------------------- <br /> [Tit�e) _,_dl------------------------ <br /> I [Plot pian, showing size of lot, Iota+ion of s em in relation wells, buildings, efc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> --------- .. DATE-------- �- ----•••. <br /> APPLICATION ACCEPTED BY ifs ��} . <br /> ------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------ ---------------------------------------------- DATE_--------------------------------------- <br /> BUILDING PERMIT ISSUED----•------------- •-----------• ----------•-----------------------------..._ <br /> -------------------------- DATE--------------------------•--------------------•------------ - ! <br /> Altera+ions and/or recommendations--------------------------- ------------------------------------------------------------------------------------------------------------------------------------ <br /> -----------------•----•--•----------------------------------------------- ------------------•-----•----- ---------•- -------- --------•----------•--- <br /> ----------------------•---•-•---- <br /> ` --------------------- <br /> ------------------------------------­--------------------------------------------- ----------------- <br /> --- <br /> •-------------- P <br /> ------•------------------------ 1 <br /> FINAL INSPECTION BY:------ - IAlv�- <br /> SAN <br /> Qate = /�--`-�--y`---------------------- --------•-JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy. California <br /> ES-4-2M Revised W-2100 �� <br />