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APPLICATION FOR SANITATION PERMIT Permit Nd�­S:: ----- <br /> (Complete in Duplicate) Q Date Issue - <br /> -x - <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to con s# uc# and install the work herein described. <br /> This application is made in compliance )kith County Ordinance No. 549. <br /> 3 <br /> JOB ADDRESS AND LOCATION_.. <br /> •--- <br /> #" `L.f <br /> --------------------------------- Phone- <br /> Owner s Name---------- <br /> ,., <br /> Address -•• •- <br /> O'--------------- --------•- -------------------- ----------•--------• ----------• ---------- --------•-------- .......... <br /> Contractor's Name------•--- --- •---•-----•--•--- -�-1-- •----�--- °--�--------- -- �- - --'------------------------- <br /> Phone �/ � <br /> Installation will serve: 'Residence Apartment Hous Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: __/__ Number of bedrooms <br /> ,2--- Number of baths _ _. Lot size """"___ ---' 21� 4:1-5-•------`------- <br /> Water Supply: Public system Community system [I Private ❑ Depth to Water TablIo t. <br /> Character of soil to a depth of 3 feet: ':Sand ❑ Gravel [ISandy Loam ElClay Loam F] Clay ElAdo' A—* Hardpan ❑ <br />! No New Construction: Ye No E] \\ <br /> l -Previous Application Made: Yes ❑ <br /> TYPE OF INSTALLATION AND' SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> ptic Tan . Distance from nearest well_________________Distance from foundation--------------------Material______"______..._.___________.._____--_---_"""-- <br /> No. of compartments---- ---- ---------------Size----------------------- Liquid depth--------------------------Capacity <br /> s <br /> --. <br /> Disposal R Id. Distance from nearest well------ - from foundation----------___-------Distance to nearest lot line----------------- <br /> Number of lines-----------------------------------Length of each line--------------------------- Width of trench------------•-------------------- <br /> % Type of filter material-------------------------Depth of filter material--_------------ --f---Total length----•------•----•----------------- <br /> f ._a .��- <br /> . _, � ��.___._�}Dista ce to nearest lot I'sne___ <br /> I Seepage N -� 7Distance to nearest well_., V�---Distance om fou -a#ian_�, <br /> Linin material _ - �-- -- ---Size: Diameter----- <br /> Number <br /> .... ------ <br /> t Number of pits-------1----- - -- g.. , <br /> I Cesspool: Distance from neares# well_____________'_.'Distance from foundation__-_______,:__:_n..L Ing material_.-_____..____.---------------14r <br /> Size: Diameter= === = -.Depth -------•------------------ ----- -Liquid Capacity---------------------------- <br /> ,�. ----------------------------- <br /> Privy:. Distance from nearest well------------------------------ Distance f r nearest)building------ "----------------- ------ <br /> ❑ •x Distance to'nearest'lot-line----- -----> ----- -----------------• - --------------j --------- ' <br /> ------------- <br /> Remodelin a ar repairing (describe). " {= <br /> g p g ( ) l <br /> ri -------------------------------------- <br /> ---------------------•-----------••---•---•------•---------------------•-------------------------•------- ... <br /> I ' --------- ---•---------------•-------"--------------- - <br /> I hereby certify'-#hat I have:prepared Ais.application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat s,,and r as d regul .ti n of the San Joaquin'Local Health District. <br /> y _ 4 <br /> (Signed)_ w e t <br /> O n r and Contrac or <br /> I -- ---"--- <br /> (Title �"_ <br /> By-- ------------------� a-- <br /> �-= = -------------------------------------• p, <br /> i (Plot pian, showing. size o ot, location_of system in relation to wells, buildings, etc., can be don reverse sid <br /> ;,. <br /> l FOR DEPARTMENT USE-ONLY <br /> APPLICATION ACCEPTED BY -�'------- -------- -- !-----•-�----- ----------- ------- DATE--------------------------------- <br /> DAT <br /> DATE <br /> REVIEWED BY_ �----------=------------------ ------------ ---------------------------------- ------------------------------ BATE. <br /> ----------•--•---- - <br /> BUiLD1NG PERMIT ISSUED---•--------------------------------- -------- - <br /> 1 Alterations and/or recommendations:----------------------------- ----------------- ---•------------------------------------------- <br /> -----•----- rc1s�' --:� t'<��cz ---- <br /> ---------------------------------------490------ horra� <br /> I ----- �1� ' ? < i� - <br /> Date— <br /> � �., ... frt 'c <br /> 1 SSSS '-- 7- <br /> FINAL INSPECTION BY:- <br /> ... ------ i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> f30 South Cali <br /> Street Manteca, California Tracy, California <br /> Stockton, <br /> CCalifornia Lodi, California ; <br /> Gt-a-7Wf : I Revised W-2104 <br />