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APPLICATION FOR SANITATION PERMIT Permit No. ._.-------------- <br /> (Complete in Duplicate) _2 �J <br /> Date Issued - --- ------- <br /> Applicaa-ion 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 Ordinance No. 549. 2,3 S-- q2t_e—a <br /> JOB ADDRESS AND ATIO _ ti_ <br /> 4 - - 'ird-Qd, -------------------------------- <br /> Owner's <br /> --- ------------------ <br /> -- <br /> Owner's Name----- - _ - ------------ - ------------------------ --------------------- Phone--------------------•-••-------- -- <br /> Address ��10t.-----•---- e - ... -- --•--•-------- -------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name--.-- Phone----------------------------------- k <br /> Installation will serve: Residenc;-(-'6\Number <br /> Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -__ - of bedrooms -_-A-•Number of baths -----1. Lot size ___. -_/ -Q---------------------------_ <br /> Water Supply: Public system 0 Community system ❑ Private X Depth to Water Table .1.5 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel X Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No k5l New Construction: Yes WNo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ��/ y <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) 1 <br /> Septic Tank: Distance from nearest well-3DW.'histance Lfrom fo�u/nda ion_____ _ _______ er�ia/l _. ________.__)l f/ <br /> No. of compartments-.----.--- � Size--1&x_1_/_1.. Liquid depth_________---- _._._Capaci}y__ZT:_TD_.__ <br /> Disposal Field: Distance from nearest weOa _T'_Distance from foundation___o;C— Distance to nearest lot line_----4...--__--. <br /> Number of lines------- ..... ........... .Length of each line-------/_�1 Width of french------ -. _�.�_____._--_-_-- <br /> Type of filter material-_- _ ____ -_ _ Depth of filter material_._. C ._For_____.Totaf long}h_____ ____.______-------------- - <br /> Seepage Pit: Distance to nearest well---?A-m_ "__Dist ance fr m fpu d ion---_-___ ........9istance to nearest lot li <br /> l� r <br /> Number of pits.-----I_-____------Lining material --_-._._ . 'ze: Diameter_'PYX-'V)-7Depth----------� ---_-•-'------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material __.____._-____--_---_-__-_-_----_. <br /> Depth Liquid Capacity -----------; �--gals. <br /> ❑, Size: Diameter---------------------- -------- ----- <br /> Privy: Distance from nearest well----------------------------------- ------------Distance from nearest building- ---------.--_--__----_____---__----.--. <br /> ❑ Distance to nearest lot kne------------------------------------------------------------------------ ---------------------------------------------------------------- <br /> Remodeling and/or repairing (describe): 714' ---14 4 --- ------- -----•----------------•------------------------ <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, tate laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ; - (Owner and/or Contractor <br /> gY� - __....... ------------------------------------------------------------------------------(Title) <br /> (Plot plan, showif ti <br /> size of lot, loc n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- - ------------ -------------------------------------------------------------- DATE---------------------------W.,g -pe---------------------- <br /> REVIEWED BY---------------------------------- <br /> ---- ----------------------------- DATE--- u},�__ �.'.c ------------------------- <br /> BUILDING PERMIT ISSUED ---- ------- ATE ' Os ------_-}Al}orations and/or roc mmendations:_aZ-f�`.. � �_.- --_ - ----- -- - V- 11D <br /> l -,�"-- <br /> �_�._ - ,,fit- _ � . _ ,� <br /> - ' <br /> -- --------------------------------------- ------------ '"` ------------------ <br /> ------------------------ ------------ - --------- --------• -------------- ------------------ ------ ------------------------------------------ ----------------------------------------------------------- <br /> FINAL INSPECTION BY: Date ---- -- -------- --- ---- ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES---9-2M Revised W-2100 <br />