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APPLICATION N FOR SANITATION PERMIT Permit No. ...u.I-- - <br /> �1 � <br /> (Complete in Duplicate). �d <br /> Date Issued ............ <br /> .._. ..�___�� <br /> IVA <br /> Appliceion is hereby made to the Sen 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 o. 549. <br /> ------------------------------ <br /> t <br /> ------------- <br /> JOB ADDRESS AND LOCATION.------- <br /> Owner's <br /> .----- ------ -- ----- <br /> Q i i------ Phone-----------------------------_ <br /> i <br /> Owner s Name------- __.. ----- --- <br /> Address ,�C0--- �3�.e.lL.az'-°� <br /> y ----- _ - -------------------------- Phone,/' dr� <br /> Contractors Name__.--- --.• - <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ <br /> Number of living units: --",,"-- umber of bedrooms ___ Number of baths -- Lot size ____ Q..___ -- - d-------------------------- I <br /> Water Supply: Public system R Community'system ❑ Private ❑ Depth to Water TabletQ! ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel F­1Sandy Loam F] Clay Loam [IClay ❑ Adobe [Hardpan ❑ <br /> Previous Application Made: Yes ❑ No BZL_ 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: -Dis nce from nearest well---_--------------Distance from foundation__________________Material __-______--------------------------------------- <br /> ❑ �� compartments-------------------- ....Size--------------------------------Liquid depth--------------------------Capacity..-------------------- <br /> Disposal Field: D• tante from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- 1. <br /> ❑ r of lines------------- ---------------------Length of each line------------ -------- -.-.._.Width of french----------------------------------- <br /> T of filter material-------------------------Depth of filter material-----------------------Total length-----------------------.------------------ <br /> Seepage Pit: Distance to nearest well_.__/(/L2��stance r m foundation_.__%_ -___---__.Distance to nearest lot line_._` -_ <br /> Number of pits--- ---------------Lining material_- �*r !�_Depth -___ ----------- <br /> Diameter--Z-3-1A, <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-.----------------.Lining material--------------- <br /> Size: Diameter---------------------- -------------- Depth-------------------------------- ------------------Liquid Capacity- ---------- --------- gals. Q <br /> l , <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ <br /> ------------------- <br /> F1 <br /> ---------------------------—----------- <br /> Q _ - = <br /> Distance to nearest lot line----------------------------------------------- ----------------------------- v <br /> Remodeling and/or repairing {describe)______________________________________ <br /> ---- -----•-----•---------•------•------------------------- -----•-----------------------•--------------•----------- <br /> ---------- -------------- ----------------------------------------------------- N <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 , and rules and regulations of the San Joaquin focal Health District. <br /> . <br /> Si ned "`-`-� ' --------- ---------------------- <br /> __(Owner and/or Contractor) <br /> 1 -4t •--------(Tittle)---- -- ---- `�------------------------------------ <br /> By:-- ---- -- -- <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 /> APPLICATION ACCEPTED BY--------- --- ------------- •-------= DATE <br /> -- --------=---------------- <br /> REVIEWED BY------------------------------------------- - -- <br /> DATE---------------=------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------ --- 4 DATE. <br /> Alterations and/or recommendations._......... --------------`--------- ___ ---------------------------- <br /> = <br /> '-----------^--r------ ------------ ------------ <br /> ---------------------------------------------------------- <br /> �--'" <br /> �----------�--- <br /> Date----- t�-------- --------------------------------- ----------••------..._ <br /> FINAL INSPECTION BY: ------------------------------------------ <br /> r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Ameriean Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9 145446 PTWOOD <br />