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ss, `'f <br /> q/�yl APPLICATION FOR SANITATION PERMIT Permit No, f SS <br /> (Complete in Duplicate) Date Issued � <br /> -- <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 /> JOB ADDRESS AND L CATION__. C <br /> Owner's Name-------- ___--UG�•--------ED-/vl_Q _Q _.-------------------------°-------------------------------------------- Phoner <br /> Address---------- ----BOX-------Y-u-I-Pte-�/_-------- H------ r---------------------------------------------------------------------- <br /> Phone----------------------------------- j <br /> Contractor's Name----- A80 �� <br /> Installation will serve: Residence �artment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __P----- Number of bedrooms --Y-- Number of baths ---I- Lot size _____�QP----;�-----�1 --------•- <br /> Water Supply: Public system 1­71Community system ❑ PrivateR--"Depth to Water Table __ ft. <br /> Character of soil to a depth of 3 feet: SEl' <br /> Gravel F-1SandyLoam E] Clay Loam ElClay E] Adobeardpan ❑ <br /> Previous Application Made: Yes '1 NoNew Construction: Yes J?rNo ❑ FHA/VA: 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 ank: Distance from nearest well__. _-----Distance from foundation---/Ci-________-.Material____. - '---• <br /> No. of compartments__.___--/-- ---- <br /> Size Liquid depth ------------ Capacity.------ QO...... S <br /> 1j Distance to nearest lot line___ <br /> Dispos field: Distance from nearest well..__�___._Distance from foundation__ ________________ <br /> Number of lines------------------------- ----- <br /> -- Length of each line------------------------------Width of trench----------------------------------- (A <br /> Type of filter material-------------------------Depth of filter material----------------------Total length------------------- -----------------•---- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_______-______-__ <br /> Number of .pits----------------------Lining material-----------------------Size: Diameter---------_-------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_-----------------Lining material-_._______--______________-_--______. r „ <br /> ❑ Size: Diameter--------------------- ------------Depth-------------------------------•-------------------Liquid Capacity----------------------------gals. <br /> n ______-___-_Distance from nearest building Privy: Distance from nearest well ------- ----------------- _ g----------------------------------------- <br /> Distance to nearest lot line.----- ------=------ - ---------- ------------------------------- ---------------- <br /> ------------------------------------- <br /> - ----------- <br /> i <br /> "ibe]-Remodelingan or repairing t --------- --------- ------------------------------- h <br /> l --------------------------•-------------------------------- <br /> -----------------•-------•------------------- <br /> F ' <br /> -- ------ - ----- - ------- ------ <br /> i <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 gulations of the San Joaquin Local Health District. <br /> ra Contractor) <br /> E (Signe )-------------- -------- ----•------- - � � ---------------- ------------- <br /> -----------------(Owner and/or <br /> Plot Ian showi size of lot, location#'af system i e�tion t {Title}----------------------------------------------------- <br /> o;wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY - <br /> "'�•�--APPLICATION ACCEPTED BY_____,____ _.�_ _ <br /> .� "------------------------------------------------- ------------------ DATE------ �� � <br /> REVIEWED BY---------------- --------- DATE-------------------------------- <br /> -----------------------=--------------------------------------------------------------------------- <br /> DA <br /> BUILDINGPERMIT ISSUED-----------:F-------- ------------- -------- --- -------------------------------------------------------------- <br /> Alterations and/or recommendations------------------------------- ------ - ---- <br /> -------------------------------------------•--------------------------------------- <br /> - - <br /> ---------------------------------------- <br /> ' ------------------------------------------------------------------- <br /> --------------- ------ ------- ------------ ------------ ------------- <br /> ----------------------- ---------------�--------------- <br /> ------------ - <br /> FINAL INSPECTION BY:__°_.___� ---- '1- <br /> 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 Revisea 1,57 F.P•CO. <br />