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yPermit No. _ 9°�--�-�---- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued __��.�30•-`5 <br /> Id <br /> Application is hereby to the San Joaquin Local Health District for a permit to construct and Ynstall the work hereinescribed. <br /> This application is made.in compliance with County Ordinance No. 549. <br /> -- - -------�-------- �7�_C:!`� -------F---------------------Phone --------- ---- <br /> JOB ADDRESS AND'LOCATION / -=----------------- <br /> -- S <br /> ------------------------ ------------ <br /> _ .... <br /> Owners Name r;r-------- <br /> -----•-------- -•-----------=-------- -------- <br /> Address <br /> ------- <br /> Address------------------�J ane. <br /> [ -[rs�.f�(_. _1Z-------- - - ----------------- <br /> Ph ---- <br /> --_ -- <br /> Contractor's Name--------------- <br /> Installation will serve: Residence ER'/'Apartment House [j Commercial ❑ TrailerY Cour} [] Motel El Other El <br /> Nunrber of living units: ______-Number of bedrooms -Y <br /> Number of baths --- <br /> Lot size _ b---- <br /> -- -----s�—� ----------------- <br /> i <br /> Water Supply: Public system FT Community system El Private Depth to Water Table <br /> of 3 fest: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[]��Hardpan.❑ <br /> Character of soil to a depth k <br /> Previous Application Made: Yes ❑ No i New Construction: Yes E►7� No ❑ FHAJVA:Yes ❑ No <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: - <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> . n <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material--._.-.-_..__"__-_--__---------_-__-----.__--._. <br /> ❑ No. of compartments---- ------------------Size---------------------------_ Liquid depth Capacity.. ; <br /> 1�_/-_--__Distance to nearest lotr��e---�-- <br /> Disposal d: Distance from neares well-e-5.:- _ -._-.Distance from foundation- Width of trench1/- <br /> - - ------------- <br /> Depth <br /> •---- ----- <br /> uy umber of lines---____-�__-- - __-- -- Length of each line---.-��-�--�-- --Total len #h----.�Q_-! <br /> i <br /> '! T e of filter' material--_ -..----=---'---,Depth of filter material------ ---------- g <br /> Seepage Pit: Distance to ngest well -_--_- Distance from foundation.......:............Distance to nearest lot line----------------- <br /> Seepage Diameter----------------------- <br /> Distance, <br /> == <br /> ❑ Number of pits_-:----------- ------LiningZafi`enal------------- d1 <br /> Linin materia <br /> Cesspool Distance from'ne�est wellf,_ Distance fro foundation.- - -.-- g els. <br /> Size: mer_ - L ` x Depth-------- - ------------------------------- Liquid Capacity a, ` g <br /> } Distance from nearest building.--_-------------------------- <br /> ---------- <br /> Distance <br /> ------------ -------- <br /> Privy: to nearest lot line - "� ------------------------------------------------------ <br /> Distance <br /> Distance from. neares+ well--------_ <br /> a <br /> ------ <br /> Remodeling and/or repairing (describe):--------- -------------------------------------- -------- ------------------------------ ------=-------••-----•-------------------------•-- ----- <br /> ,r <br /> _- --------------- <br /> y ! -------------`--- --=----=----- - ---------- <br /> -= - ---- ---- --------------- *� <br /> I <br /> " ", !, s.. AE •------------- -------------------=----------------------------------------------- <br /> ----------- -- r -.. <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;;v <br /> d *e ulations of the San Joaquin Local Health District. <br /> ' = r (Owner and/or Contractor) <br /> r --- -------- <br /> `- ---------------------------------- <br /> \� ) - ---------------------- <br /> --------------- ---- ----------- ---------- <br /> (Plot <br /> ------� - <br /> ----------(Title)---------------------------------- <br /> By:(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can•Ve•placed on reverse side). <br /> FOR DEPARTMENT USE ONLY --�­ <br /> +. <br /> APPLICATION ACCEPTED BY ' -.-------------------------------------•--- DATE - ��' , - <br /> - <br /> . ATE----- ----rr--�• -----------------------••-------------- <br /> REVIEWEDBY-------------- -----------------------=---------- --------------:-F ---------_-- - s DATE F <br /> == `- ----------------------- <br /> BUILDING PERMIT ISSUED---------------------=--- - r <br /> Alterations and/or recommendations:_-----___--_ __ __- -- _ <br /> ' •---------•--------------------------------------- <br /> ------ -------------------------- <br /> ------------------------•------•--- <br /> --------- -w, <br /> ------------ <br /> -------------• --------------•------------------- <br /> � <br /> :� Date--- = f------------------------------------------------ <br /> FINAL INSPECTION BY:.---__- _ -- - ''` ; <br /> " 4 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 sycamore Street 014 North "C" Street <br /> 130 South American Street 300 West Oak Street y <br /> Lodi, California Mentees, California Tracy, California <br /> Stockton, California <br /> E5-9-2M . Revisea 1.57 F.P.CO- <br />