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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ----'�x <br /> Ajpplica+'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. <br /> Tri <br /> . <br /> JOB ADDRESS OCATION___ ...... <br /> Owner's Name <br /> - ----- ----------- ---------------- ---------------------------------- Phone_ <br /> Address. ffl_t._9------- 617 <br /> Contractor's Name... .. . ...... <br /> Inst I allation will serve: Residence E] Apartment House D Commercial E] Trailer Court E] Motel k-0TFe_,_b <br /> Number of living units-.1-q- Number of bedrooms 2"p. Number of baths .2___ Lot size —---------------- <br /> Wafer Supply: Public system El Coalim'unity system [_ Private [Depth to Water Tabled--67-'ft, <br /> j <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam [] Clay Loam E] Clay E] Adobe El Hardpan <br /> Previous Application Made: Yes [-] No New Construction: Yes El No C�—, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well------------- ---Distance from foundation-------------- --.Material_._______.-______.___.__ ___ <br /> ---.Maferia <br /> _11_144t� No. of compartments-- ------- ---------------Size--------------------------------Liquid depth-------------- - --------Capacity----------------------- <br /> -/Disposal Piela: Distance from nearest well..- ----------Distance from foundation-5.0..... ....Distance to nearest lot line.-9 <br /> Number of lines-------- --,r--- Length of each line/Jo ......Width of french ---- <br /> Type of filter material.-/.'.--.. fD.,th of filter material--_/e_"_.___Tofa1 length--- ----------------------- <br /> Seepage Pit: Distance to nearest well---------------------.-Distance from f undation__/6W__'__.Distance to nearest lot <br /> Number of pits <br /> -----�?-----------Lining materia;_ r I T I <br /> ,11&4 -- -_.-Size: Diameter_Si -1a.-O-- <br /> - --- ---- p5 <br /> A--- Deto-- ----------------- <br /> Cesspool Distance fromnearestwel--------------.--Distance from foundation--------------------Lining material-----.--_-..-_.----__--.-- <br /> .w>— Di" <br /> aterial---------- ----------------------- <br /> Size: Diameter---- ------ -----------------------Depth---—-------------------------------------- -----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest weJl------------- ---------------------_----------Distance from nearest building------ <br /> 0 Distance to nearest lot line------- --------------------------------------------------------------- <br /> 144 <br /> Remodeling ani/or repair:ng (describe):-- ---------------------- ------------------------------------------------------------- <br /> --------------------------------- -------------------------------------------------------------------- ----------------------- -------------------------------- ------------------------------------------------------ <br /> -------------I.,----------------------------------------------------------------------------------------------------------------­------------------------------------------------------------------------------------------- <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 anA regulations of the San Joaquin Local Health District. <br /> d&4,& A <br /> (Signed)---- `0 <br /> ------------------ <br /> By:------ • •_41_ 1— - ------ -------------- ----------------------------------------(TiflePC <br /> -size-of-lot;- - ------- <br /> �-tPlof-plan-�showing location-of-system in-relation-to-w efls,76uild i ngsi-efczi=can-be-pl_a.ced-on-reverse side)- ------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- - ----------- ------------- --------•------------------------- DATE---- --- / <br /> - <br /> - --------- <br /> REVIEWED BY--------------------------- ----- ------------------------ ------ -- ------- ------ -----------.. DATE.... <br /> BUILDING PERMIT ISSUED-_--------------------------------------- - -------- ----------------------------------------- <br /> ------------------------------ ------------------------- DATE------------------- <br /> Am <br /> lterations and/or recomendaf ions:------------------------------------------ <br /> , IN 7-------------------------------- <br /> -------- ---------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- <br /> ----------I---------------------------------------------------------­------------------ ---------------------------­----------------------------------------------------------------- -----------­------------------- <br /> ------------------------------------- ----------------------- ---------------------------------------------_---------------------------------------------------------------------------------- - -------------------------- <br /> -------------- ....... ------------ ----------------------------------------- ------------------- -r- <br /> -- <br /> - - --------- G <br /> --------- ------ --------------------------------------- ---------- <br /> FINAL INSPECTIO -- --- - <br /> - - -- - ------------------------------- - Date--------: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Sfreof <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> EE---9-2M - 145446 ATWnOb 12.54 <br />