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APPLICATION FOR SANITATION PERMIT Permit No. •. - __ <br /> (Complete in Duplicate) <br /> ' /tionis <br /> Date issued <br /> 1 <br /> Applibymade to the San Joaquin Local Health District for a permit to construct and instate the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-------- -- ----- • — ------- <br /> Owner's Name '-.... '' -...-------- - ---------- -------------------------------------------- Phone--_m"E F Af---lam" <br /> Address------------------ ,.�.� _ <br /> Contractor's Name - ...�.o - = ------------------------ - Phone---`7~-�z 1� 9------- <br /> Installation will serve: Residence D? Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> F <br /> Number of living units: ___f__ Number of bedrooms ___le Number of baths ._/-__ Lot size _____ _ '- -l_iT 7------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ <br /> .!96ft. <br /> Character of soil to a depth of 3 feet:l Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No M, 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 Tank: Distance from nearesr w•elLker'_Distance from foundation_10- _-____.Material,_______ __. <br /> No. of compartments--------------------- <br /> Size- 3 ---Li depth ` Capacity <br /> Disposal Field: Distance from nearest well- Distance from foundationQ__r._.__-Distance to nearest lot line'_._ •(� <br /> Number of lines_____ _________________________Length of each line /� r Width of trench-._ .7_........rn `\ <br /> Type of filter material__ .��--___ .__Depth of filter material-__-�_ .`f_____Total length___-_----7,21a - ----V'` <br /> Seepage Pit: Distance to nearest well_._- ___Distances fro fo ndation___-/_��___..Distance to nearest,} l ne--____.__�0" <br /> Number of pits_____!-------------Lining material ... Depth---- ----- ------------- <br /> Cesspo I: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------- <br /> ❑ Size: Diameter--------------------------------- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.-.----._----------------------------------------Distance from nearest building-_--.--___.__.___._-_______-___.._._-----. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------- ---- <br /> Remodelingand/or repairing (describe)---------- -------------------------------------------- ------------•-----------•--------------- ----------------------------------------------------- .- <br /> i <br /> ----------•-----------------I------------------------------------------------•-------------------------- ------------------------- <br /> 1 <br /> -•-••----------------------•---------------------- <br /> --------------- <br /> -------------------------------------------------------------- ------------- ----•------------•------------------------------------------------------ ----------------------------------------------- --- ---------- <br /> I hereby c r ' y that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances St e I ws, and rules a d regulations of the San Joaquin Local Health District. <br /> (Signed)---------- -- --- <br /> --------- ----- ------ -•------------------------------------- ------------ '{ Contractor) <br /> By:----------------------------------------------�---------------- �� -----------`------(Title)----- � <br /> (Plot plan, showing size of lot, location of system elation to wells, uildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- --------- ------------- - ----------------------- <br /> ------ DATE-------- <br /> 1l��---f� ��----- - -- <br /> REVIEWEDBY-------------------------------------------- -------------------------------- ------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------------------- <br /> Alterationsand/or recommendations---------------------------- ------------------ ----------••--------------------------------------------------------------------•-- ---------------------------- <br /> -------•------------------------------------------------------------------------------------------- ------- ---------------------------------------------------------------------------------------------------------------- <br /> 1 <br /> ---------------------------------------------------------• -------- ------------------- -- ----------------------------------- <br /> ----------------------­------------------- - <br /> --- --- --- <br /> - --------- - ----- ----------------------------------------------------------- <br /> . k <br /> ff�7 <br /> FINAL INSPECTION BY: Date------------------ ------------ <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 10-52 Revised W-2100 <br />