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1 •�� �,� ' APPLICATION FOR SANITATION PERMIT Permit No. ;L-1-7­4---- <br /> (Complete <br /> L-1-7__4-_-_[Complete in Duplicate] <br /> Date Issued __^ - _S y <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 O dinance No. 549. <br /> JOB ADDRESS <,t D L CATIO -c57 I -•---------0_0 ----------- ------------ ------------------------------ ----•----- ------------------------------------------------------- <br /> Owner's Name--- E ------- --- ---------------------------------------------------------------------- Phone_;�_`l%49.rf Z-------- <br /> Address +fir --- ; <br /> Contractor's Name-------------------------------------------------------- - .- Phone <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Curt ❑ tel P Other �s <br /> Number of living units: ___�__ Number of bedrooms _Z__ Number of baths __/___ Lot size .------ <br /> &_-p---� �/V ---------- <br /> Water Supply: Public system Community system 'E] Private ❑ Depth to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam I Clay Loam [I Clay E] Adobe�ardpan E]Previous Application Made: Yes [:] No New Construction: Yes ; o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tiF Ta k,: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- I <br /> No. of compartments--------------------------Size-------------------------- -----Liquid depth--------------------------Capacity----------------------- <br /> D•sppsa Fiel Distance from nearest well-__------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material_________________________Depth of filter material----------------------- otal length---------.______________-___-____-_-____ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-----.___-_-__- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h-------------------------------- <br /> ; <br /> Cesspool: Distance from nearest well----_____--------Distance from foundation--------------------Lining material_________________-______-___....... <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------- -------------------Distance from nearest building__-____________________..._-__--_.__---- <br /> ❑ Distance to nearest lot&11' e-------------------------------------------------------------------------------- -------------------------------•------, ----- <br /> f <br /> Remodeling an /or repairing et(ribej.___ � -"' ---------------•--------------•-----•- ���!'----�--- <br /> _-A,4---------- --- _-.•. -----. -- ------ ;-------------- ---------------------------------------- ---------------- � <br /> - - ----------------------------- ---------------------------------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed).•.. .... ----- t � ----------------------------------------------------------------------------------------------(Owner and/or Contractor <br /> By:........................................ ----------------------------------------------------------------------------------------(Title)-----------------------------------------------------------•---- Y <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- --- ------------------------------------------------I--------------------------------------- DATE_ a <br /> REVIEWEDBY------------------------------ --- ----------------------------------------------------------------------- DATE l '. <br /> BUILDING PERMIT ISSUED DATE ---------------------------------------- <br /> Alterations <br /> ------------------------------------ - <br /> Alterations and/or recommendations----------------------------------------------------------------------------------------- ---------------------- <br /> --------- -------------------------------------------------------------------- --- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------- ------------------------ ------------------ --- ---- - ----------------------------------------------------------------------------- <br /> FINAL <br /> ------- ------FINAL INSPECTION BY:-----�4/--�--' ---------------------------- Date r` ={ `- " <br /> ------------------------------------------------------ <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 /> t <br /> ES-9-2M 8-51 Revised W-2100 <br />