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4� !� APPLICATION FOR SANITATION PERMIT Permit No. ;Z <br /> (Complete <br /> (Complete in Duplicate) _ <br /> Date Issued.•_1__--- <br /> � -_3 <br /> ^� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thework <br /> This application is made in compliance with County Ordinance No. 549. k herein described. <br /> JOB ADDRESS AND LOCATION.----/-(e- 4!, <br /> --- - -- ------------- ----- <br /> -�` <br /> Owner's NameE ` <br /> --------- ---------------- Phone <br /> -�/ -------- <br /> ----------------------------------------------------------------------------------------------------------------- <br /> ---- ---- '��7 !CQ 40-e-6 <br /> Contractor's Name_-_D{_A!______ <br /> --------------- ---------------------- <br /> Phone_ '"` _ __ <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _-/-- Number of bedrooms -.2-- Number of baths __ Lot size .._--_ -- <br /> -- IIs_A--j--dr6 '-------------------- <br /> Water Supply: Public system [) Community system •❑ Private Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe tK Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes x 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 nearest well-__c0_� Distance from foundation-__- <br /> No. of compartments----_ --=-----------Size-_ 1�__,_j_4.. D-Liquid depth <br /> ------c-ro?-------------Capacity <br /> Q <br /> Disposal Field: Distance from nearest well-----J _"_.Distance from foundation------la_'_-_-Distance to nearest lot line____ _ <br /> Number of lines__________Z­.k-l�_--______-Length of each line------Y_-, _O---------- -Width of french-------- <br /> Type of filter material---/,5_-_,/T,+,,__Depth of filter material----_-A __Total length---_.-_�f,.1.2--o----------------------- <br /> Distance Pit: Distance to nearest well__ Distance from foundation-------------------- <br /> Distance to nearest lot line--____----_._____ <br /> ❑ Number of pits--•-------------------Lining material--------------------_Size: Diameter------------------------Depth------------------------ <br /> esspoo : Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------- <br /> -- <br /> --------------- <br /> Size: Diameter-_. Depth------------------------------------------ - -----Liquid Capacity----------------------------gals. + <br /> Privy: Distance from nearest well-----------------------------------___----------Distance from nearest building <br /> ❑ Distance to nearest lot line--------------- <br /> ----------- <br /> Remodeling and/or repairing (describe):------------------------------------------------------- <br /> ------------------------------------------- <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 Joaquin County <br /> ordinances, State laws, and rules and, regulations of the San Joaquin Local Health District. <br /> (Signed)----P ----- --- -- ------- ------ --- ------` I - +' ----- ------------- "+-ITd/ r Contractor <br /> By:----- x - Title--- . ) <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 /> 1 <br /> APPLICATION ACCEPTED BY____ DATE__ <br /> ------------------------------------- --------------------------------------------------- <br /> BUILDING <br /> REVIEWED BY----- ------------- ----------- �------------------- ---------- •-------- ------ <br /> ----------------------------------------------------------------- ------------- DATE-------------------- <br /> BUlLD1NG PERMIT ISSUED __ <br /> ------------ DATE — <br /> Alterations and/or recommend ations: --------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- <br /> --------------------------- <br /> ----/ <br /> J' r <br /> FINAL INSPECTION BY:---______ f:_.- �` -� <br /> `�-h=,-'--`---- ---------�----� ------------- Date------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I <br /> Stockton, California Lodi, California Manteca, California ; <br /> Tracy, California <br /> ES-9-2M 8-5i Revised W-2100 <br />