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} APPLICATION FOR SANITATION PERMIT emit No. ,,S_ ---- <br /> (Complete in Duplicate) <br /> Date Issued ___ ��`'s_- <br /> Applica+ion is hereby made totheSan Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This a pplicat.ion,is.made.inrcompliance with County Ordinance No. 544 z) Q eS3,0--,Z? <br /> JOB ADDRESS AND LOCATIO ----------------- ---------1---_.' ----�-!�.--•---•------------ I <br /> Owner's Name---------------•-----------4- -n d � �d '�e„��2_v�_:��� � Phone <br /> Address--------------- - - .. ...... -------- -•---_�Pz----------.-------------------------...--------- <br /> Contractor's Name---------------------------------- ? --"------------------•-----------------"---"----------------- --•--•--•----- Phone----------------------------------- <br /> Installation will serve: 'Residence M, Apartment House E]r Commercial ❑ Trailpr Court ❑�yMotel ❑ Other E]Number of living units: __1____ Number of bedrooms _ __. Number of baths _` Lot size QV_�----/ , 4 <br /> -------------------------------- <br /> Water Supply,: Public system g-L Community system ❑ "P6ate D Depth to Water Table -------- ft. 41, <br /> f <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Clay ❑ AdobeA. Hardpan ❑ <br /> Previous Application Made: Yes ❑ No J�5-- New Construction:,Yes No ❑ N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: k; ` �x. <br /> (No septic tank'or cesspool permitted if public sewer is available'within 200 feet.) <br /> Sep i5Tank: K Distance from nearest well---- -------Distance from foundation__" --- ---- Materia."__ .____"""_."""____ <br /> i No. of compartments"_"-".._- ---_-__.__Size___ KIoX:.Liquid depth- 2'd------------Capacity____" -_�Q_-----_ <br /> Dispo I Fie4d:; Distance from nearest well..'y^__.._'.Distance from--founda ion___�0��__Distance to nearest jpt line____s5 "" <br /> Number of lines________ .__._ _ ._ _ gth of each line_ _______ ____ _ Width of trench <br /> ', �Q:.Len ;r� <br /> Type of filter mi__ ri ___ 4Qepth of filter material:__._- Total length-__'___.___ �ll_________________ <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 materia --------------------------------- <br /> ❑ i Size: Diameter_ ---------`Depth----- ----° ----------------- --- -----Liquid Capacity----------------------------gals. <br /> Privy:' Distance from nearest vrell----------------------------- --------------Distance from nearest building--------_------------------------------._.` <br /> ❑ _ '�Distance'to'neareslllot line:--­"—_ �* � ------–"r-.--`-------------------------- - ---------------------------------------- <br /> 11 <br /> Remodeling and/or repairing (describe =---------------------- ---4-- -----------•-=---------------------••----------•-----•------------------------------------------------------------- <br /> - <br /> _ s <br /> ---------=------------ <br /> ----------=-------•------------------------------------:-------------- ---------------------------------------------•------------.....--------=------------------------------------------------•-••-------•---------------- <br /> I;hereby certif t l have pr� ed_this application and-that•the work will be done in accordance with San Joaquin County <br /> ordinances, Stat s,`and les ,regulations of the San Joaquin Local Health District. <br /> f � <br /> (Signe _ . a -------- -------------------------------= (Owner and/or Contractor) <br /> --- - ------- = --= ----- { ------------ -.Tale)-------------------------------=-------------------------------- <br /> (Plot plan, showing ' e of lot, location of system-in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- ---------- } •----------- ------------------------------------------ DATE-------- <br /> REVIEWED.BY--------------------------------------------- -- - --------------------------------------------------•------------------------ DATE-------- -----•----------•---_ --------------------- <br /> BUILDINGPERMIT ISSUED---------_---­----------------------------------------------------------------------------- ------ DATE------------------------------------------------------------- <br /> Alterations anc�/or reco mendati - --------------:----------------•----------------•-----------•------------------- <br /> ----- - <br /> ------------- -- ------• --------------fibe d._ .__c ...., --- ...._ <br /> ------------------------------ ------------------------------------------ ------------------------------------------------- _ ---------------- --------- -------------------- --------•-------------- <br /> s-- <br /> FINAL INSPECTION BY:: "? ------------- Date ----- -rte <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, Caiifornia- <br /> ES---4-2M Revised W-2100 <br />