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APPLICATION FOR SANITATION PERMIT Permit No. __1.�---!............. <br /> V (Complete in Duplicate) y d� <br /> Date Issued ..-... .r3I���. <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 County Ordinance No. 549. <br /> a l �__ --•-- ------- --------------------------------- <br /> �1�J l�JOB ADDRESS AND LOCATION_________________ _._ __-.. - - - -- -- -- <br /> Owner's Name------------- ---------------I-- --------------------------- ---------- Phone._2 aa_�M�� <br /> Address------------------------------ _ft�-k.___' .... �.,:.- _. ;R' <br /> ��d <br /> Contractor's Name-------------- ------------------------------------------- Phon -------------------- ------ t? <br /> Installation will serve: Residence 2--'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ po <br /> Number of living units: /____ Number of bedrooms �_._ Number of baths --,/___ lot size __ .---/ra _____ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Wafer Table 4/ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er-Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 2'- New Construction. Yes P3- No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: d <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest weil�J�l�_L_-Distance from foundation__ .____.M/aterial_ - -- <br /> '-- <br /> No. of compartments------�--------------Size_S�/, ---- ---Liquid depth--- Ce- -------------Capacity_..__.? ------ <br /> Disposal Field: D+stance from nearest well--4-4)., Distance from foundation_JD_r_.__`.Distance to nearest lot line----------------- <br /> 10 <br /> Number of lines______.------------______-_Length of each line-----——_s _._.Width of trench____ _------------________ <br /> Type of filter materialSe_� -----Depth of filter material----j�'__.__.____Total length-----�~S___________________________ `u <br /> Seepage Pit: Distance to nearest well ._9 _______._Distance from fo ndation_. ____.__.Dista�ce to nearest lot line--- [` <br /> Number of pits____ ______________Lining mate ria l ._-Size: Diameter__� ---._------ D <br /> ---- epth._i�F_�f_____________- <br /> Cesspool: Distance from nearest well-----------------Distance from found6fion__.----------------Lining material----.-------------------------------- <br /> E] Size: Diameter--------------------------- ----------Depth------------------------------------------ --------liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. <br /> ❑ Distance to nearest lot lire-------------- ------------------ ---------------------------------------•--------------------------------------------------•---------------- <br /> Remodeling and/or repairing (describe= ----#_ <br /> -�__. - u�-fes-� [ f e____:.: #----------------•......---------------------------------------------------------------------- <br /> ------------ -----------------•-------------------------;-.--------------------------------------•.-.-----.--------- ....----------------.-.------.-.-------------------------------------•--------------------------•------- <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, State laws.—and rules <br /> ,and <br /> reg�ulations of the San Joaquin Local Health District. <br /> ---1 l-I �-- -_ _� _—c---------- -----------------------------•------------------- -v-(Owner and/or Contractor) <br /> (Signed)------------------- ----------------------- --- <br /> -.c- '-P := (rtle) ! <br /> (Plot plan, showing size of lof, -------------------- <br /> . 13 ion of system in relatio�,oells, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------- --- DATE <br /> REVIEWED BY -- - - - -- ------------ <br /> ----------------------------------------------------- <br /> ---------------- --------— -- - ---------------- - DATE- r ..._. .. <br /> BUILDINGPERMIT ISSUED-------------- •-------------------------------- ----------------------------------------- ----- DATE---------------------------------------------------------- <br /> .. s� - <br /> Alterations and/or recommendations - <br /> ----------------------- <br /> r'-------------­--- / <br /> ------------------------------ -Q-- <br /> '(`". * `�.". _ 'Q"'-`- -• - ----------- <br /> --------------------- ---------------- <br /> ----------- <br /> -------------- <br /> -------------- <br /> ----- <br /> FINAL INSPECTION BY:. --------------------------- Date_...- -< Z - -----.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> IlkES-9-2M 146446 ATwooa 12-54 <br /> 4 <br />