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1 <br /> APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica*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 <br /> /County <br /> �Ordinance No. 549. <br /> _ � -------------------------- <br /> --- <br /> JOB ADDRESS A OCATION------------------------------- -- l ------- --- <br /> 94 <br /> 11 <br /> Owner's Name-- --- - ---- -----••--- - -- - -------�-----------------....--- - ------------- <br /> -- ----.. Phone . <br /> Address----- R ----------------•--------------- ------------------------•-------------•Phon--------------------•----------------- <br /> a <br /> 37 <br /> Contractor's Name- -------------------•--•---------------------------------- -------------------------------- ------- - G Q <br /> 9. <br /> r Installation will serve: Residence ❑ Apartment House F21-IXCommercial ❑ Trailer Court ❑ Motel ❑ Other <br /> ppa `X . <br /> Number of living units: - --- Number of bedrooms _ - Number of baths _ --- Lot size _--O_...___- - !®---_-_.-_-------------------• <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table-.'/' <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe�ardpan ❑ <br /> Previous Application Made: Yes ❑ No D New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> „ <br /> eU,icank� Distance.from nearest well------------------Distance from foundation.-------------------Material---------.------------- _---.-.._-----.--__-.--. <br /> No. of compartments----- ------ -------------Size---------------•----------------Liquid depth----------------- ------ Capacity----------------------- <br /> osal Fi d: Distance'from nearest well----- .....Distance from foundation--------------------Distance to nearest lot line----____-_--_- \1„4 <br /> Number'oi lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type oT,filter material-------------------------Depth of filter material-------------.___---..Total length-----------------------------.------..----r <br /> Seepage PDistance to nearest/well__/40--_-_--_Distance rom foundation----f_.�--------Distance to nearer o <br /> Number'of pits._.__/---------------Lining material)_.C_k---_-Size: Diameter-_ Depth -_vZ- .-- - __- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material---------------.-------------- -- <br /> ❑ Size:Diameter------------------ ----------------- Depth----------------------------- ------------- .Liquid Capacity--------------- � <br /> �. . <br /> Privy:. Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> ❑ Distance to nearest lot line------ ------------------------------------------------------ ------------------------------------------------------------------------------j <br /> Remodelingand/or repairing (describe):-------------------------------------------•----------------------•---------------------------•-----------------------•-----------•------------------ <br /> ----------------------- ---------------------•------------•--•----------------- .._._..-.--------------------=-------•------------ <br /> ------•-----------••----------•----------------------------------------------•------------------------ --- ------ ---- <br /> = ------ ----------------------------•--•-----�-------- -----------------------------------------------------------------------I=--•-------=------------------------ --------- <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, 7-1 <br /> aws, ander s and regulations of +he San Joaquin Local Health District. , <br /> (Signed)•------ -•-------------------------•---- -- - - - - Owner and/or Contractor) <br /> f, <br /> B �j__ A ` `� --------------------------------(Title}--- �' r' 1 /7---------- <br /> Y:-- ----- d <br /> (Plot plan, showing size of lot, location of system in relati (n to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED. BY------------------------ ----- ------ ---- DATE-...- " <br /> REVIEWEDBY---------------------- -------------------- .... ---------- -- ----------------------------- DATE J -.-.. <br /> BUILDING PERMIT ISSUED ----- ------ DATE------ ----- -------- <br /> Alteretion and�o rec�m ndat ------------------------ <br /> ---------- <br /> ------------ <br /> ^ <br /> Q5;.o* ---•--------- --------- --- --- <br /> --------- ... <br /> ----------- ----- --- ---.-----• ---- --- - - ------ ------­:---•-----------------•--•---------•-------------------...--------- ----•-----------•--•------- -•---------- <br /> �' ! ' <br /> FINALINSPECTION BY:----�.�--------------------------------------- Date---;-�--�------ -------------------------------------- <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 /> ; ES-9 145446 n'rw000 <br />