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} APPLICATION FOR SANITATION PERMIT Permit No. ,3---�.T1 <br /> li <br /> (Complete in Duplicate)v Date Issued _____ ___7_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thcNork herein described. <br /> This application is made incompliance with Courify Ordinance N-_.549. <br /> ^^�� ti -`-- <br /> JOB ADDRESS )f'L0 Tl _, ± E -- -------------- .4``JL. - <br /> Phone.Owner's Name__ - __ <br /> Address. - - - --=---------------------------------- ---- <br /> --- <br /> Contractor's Name--- --------- 1-------------------------------------------- -----------------,1---------------------•----------------------- Phone--------•--•----------------------- { <br /> ------ ------ <br /> Installation will serve: Residence Apartment House Commercial E] Trailer Court ❑ ofej ❑ Other <br /> J--- <br /> iq, <br /> Number of living units: _1__-- Number of bedrooms_ Number of baths -�____ Lot size ----_________________-___ _______-______.___-__ <br /> Water Supply: Public system ❑-"Co-mmiinifiy sysfe;r6—E—`Private''❑""'Depth-to W6ter Table __,__-. ft. <br /> Character of soil to a depth of 3 feet: Sand a Gravel E] Cl <br /> Sandy Loam Clay Loa# ay El Adobe Hardpan ❑ <br /> Previous Application Made: Yes E] N0 <br /> Sand <br /> Construction: YesNo E] <br /> INSTALLATION AND SPECIFICATIONS: <br /> TYPE OF INSTALL E <br /> (No septic tank or cesspool permitted if ublic s wer is available within 200 feet.) '� <br /> Septic ank: Distance from nearest wel ista c� {.ro %Lin fion___�_ _-______.Mate :�i__ �J _- _-------. ��' <br /> f ''Q <br /> No. of co partments -f.__-__ --- <br /> Siz }C( l1_ -- ---Liquid depth--------Ff'------------Capacity--••-g----- <br /> } <br /> S <br /> Dispo I Field: Distance from nearest wg_� '._--- istance from foundation___ __�l_!--/-.Distance to nearest lot li/ne_r�_ --... <br /> Number o� lines---------- <br /> __-_ Length_{ of each line_____ ---.Width of trench________ _`t' <br /> De th of filter materia-------�q► I Total length------------ ---r. -------------`---- <br /> Type of fitter mater181 _ �� p (1 <br /> Seepage Pit: Distance tj nearest well° ""':"_."" 'Distance from foundation___ . _.__..Distance to nearest lot line________________ <br /> ❑ Number of pits----------------------Lining materill-----------------------Size: Diameter------------------------Depth-------------------- <br /> Cesspool: Diltance from nearest well_________________Dista ce from foundation_--________.__.__--Lining material....--------------------------------- <br /> - <br /> ❑ Size: Diameter_--- Dent —= ------------------------- puid Capacity-----------=-------------- gals... <br /> Privy: Distance from nearest well-------_-----------------------------------------Distance from nearest building_____...__-___.________--_.-__._.__.-----. <br /> �] Distance to nearest lot line------------ I--- ----------y!-------------- ------------------------ --------- ------------------------------ --------------- ------------ <br /> Remodeling and/or repairing {cles&ibe)•e---- r =----------- -------- --- --------- - - ------ --•--•-------- # <br /> ----- <br /> ------------------------ <br /> - ----- ��-'---� � - a _ _----- r -- rx - '----`-----� _ --- ---------------------- <br /> ----------- <br /> ------------------ <br /> l - _ J" R.,�f s - -- -- ,�5 - �"�_ `.�------------ <br /> ( At = '� - ------- <br /> --------------------; - ( s <br /> I hereby certify that I have prep red this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat laws, and.rules and regulations of the San Joaquin Local Health District. f.` <br /> t -----------------------------------------------------------------(Owner and/or Contractor( <br /> (Signed)--•---.-- -----�s�" ------ ----- <br /> SY- '' ------------(Title)--- ----------------- •-------------------------------------- <br /> (Plot plan, showing size of lot, location of system in red tion to wells, buildings, etc., can be plat ed on reverse side). ' <br /> FOR DEPARTMENT USE ONLY <br /> t <br /> APPLICATION ACCEPTED BY -------- =---~---- =--------------------------------------------------------- DATE- <br /> BUILDING PI RMIT ISSUED. _ <br /> [ . DATE------------A <br /> REVIEWED BY <br /> }ATE <br /> -- -----------------------•--•--- <br /> Alteratians and/or rec4mmePdations:,.._:,,_�:.�.��.::;;:�-�-- ---------=---u=--,.��,-------..,-:_._�.._.1.-,=--•-------••-•-•-- . <br /> � ---•-------------------------------------- • _ <br /> .��---------- -------------------------------------�--------------•---------.-...-------------...-----------------•--•------------------- <br /> ---- - ------------------ �r. �._- ,e-" rt� f ,••p•'Isr'.. ¢ A ► ,_:� '�� ------------------ -- -- -••------------ ----- �- <br /> 1 1 .,-�sf bre cf.Cri m----�---- <br /> /_ f 97 <br /> - . <br /> -----' _ -----`•--------------- <br /> -•------ --• <br /> J­1437f{ -----------•---_.-._------'----•--------------------•------ --------------------- <br /> .,�6�z_ <br /> FINAL INSPECTION BY-- --------------- --- <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 /> Stock+on, California Lodi, California Manteca, California Tracy, California <br /> E5'`•4-21x1 10.52-Ravised W-2100 <br />