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SANITATION PERMIT Permit No. <br /> APPLICATION FOR 5 --�--�--�---- <br /> ?- li <br /> D <br /> i <br /> t <br /> C <br /> ( omplee n. upcate) <br /> n� _ Date issued <br /> . f. <br /> Apl5lication is hereby made to the,-an�"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 /> JOB ADDRESS AND LOCATION-----�-t47,2 ----7-------- -------------------- ------------------------------ <br /> Owner's Name---------------_ "'..'_'- �J-- <br /> �" :. .- <br /> ----------- <br /> "' <br /> Phone <br /> Address-------------------- -----------------------•---------------------•------------------------------------7....... <br /> Contractor s Name-----�--------------•-------------------------- ,��3�-.-------- -----------•--------- -------------------- -----------•---- <br /> _ Phone----------------------------------- <br /> I � <br /> Installation will serve: fResidence,' Apartment House F1 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms. N,umbee..of,�baths,„. Lof sib=--------------------------- <br /> �/ 1 `ev <br /> Water Supply: Public system +< Communi4%system ❑ Private ❑ Depth to Water Table -------- ft. I <br /> Character of soil to a depth of 3 feet: Sands Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ac obHardpan ❑ ` <br /> Previous Application Made: Yes ElNo ElI NA Construction: Yes ❑ No El <br /> TYPE OF INSTALLATION AND SPECIFICATlONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> SeKiank: Distance from nearest well______ _______'_Distance fr:dm foundation.-_�;--------_M�tenial_____---_______-_-.________---------------------. <br /> No. of compartments---- I------------------ Size------------------ - Liquid depth ------- ---------- Capacity <br /> Dis o I Field: Distance from nearest weli__.__ ___ -Distance from foundation._ -- ~---b.istance to nearest lot line___._____- <br /> �[?_'!:-+.Width of trench.---------:�--`.r---------- <br /> Number o1 lines_____________ x -�7"""`tength o of ach line________-____ <br /> y /} �i jj <br /> Type of filter mattenaL _ :_lti/trQDepth of filter material___. --- <br /> length___ ----------------- <br /> Distance ------- <br /> I I <br /> Seepage Pit: Distance to nearet well_____________________Distance from foundation--------------------Distance to nearest lot line___._____________ <br /> ❑ Size: Diameter- ------------------.De th-------------- ------ <br /> Number of its-----:----A----------Lintng material --- t t P <br /> Cesspool: Distance from neares+'well_________________Distance from foundation--- Lining material_________.._____._-------------- <br /> ❑ Sizu: Diamet r ----- i.----------------------Depth---------------------------•`-----------'--- ------Liquid Capacify---------------------------gals. <br /> ' c <br /> Privy: Distance fro nearest well_______._________________________________ ____Distance from nearest building__-______._---__________-----. <br /> °� ❑ Distance to nearest 1pt#line------------------- --------------------- ..--------------------1------------------------------------ <br /> Remodeling and/or repairing (describe)------------------- ----------------------------------------------•--------------------- •------------------------- 9 <br /> --------------------------- <br /> i ! <br /> w l <br /> ---- <br /> e - iy ----- --- -----------------------------------------------------------------------•-•-------------------------------------------'----------------- ------------- --- <br /> h --- -------- <br /> I hereby certify it I have prepared this application and that the work will be done in accordance witli San Joaquin County <br /> ordinances, State laws, and rules andregulations of the San Joaquin Local Health District. <br /> 1 (Signed)_.___ A�,_T_A nl� _11�*4A------------------------------------------------ -------------------------- <br /> ______________(Owner and/or Contractor) <br /> Tale <br /> ---- ---•-••------------ `-------------------------,-------------------------------------------- (Title)---------------------------- <br /> ----------- - ------------------------- ----.- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By..... �°� DATE------------- -- <br /> ----- ------ <br /> ------------------- <br /> t .— <br /> REVIEWEDBY----------#------------------------ ------------------------ DATE-----------•--------_-.----------------------------•------- <br /> BUILDINGPERMIT ISSUED--------------------------- - -- DATE.-----------------------------------------------------------• <br /> Alterations and/or recommendations:4------_------..�•-- _.�,. �------------------------------ -----------------•------------------------------------•------------------------------ <br /> 1 -----------------------••-•------.._...--------------------------------- <br /> ------ ------- ------------------------- - ------------------------------------------------------------------------------------ --- <br /> --------------------------- <br /> --------------------------- -------- ------------------------------------------------------------•- ----.. <br /> -------------------------------- <br /> ------------------------•------------------------•------------------------------------------- <br /> I7 Z7------------------------------- <br /> FINAL <br /> INSPECTION BY------- ---------- -- -- --- ------ - ------ Date.------------.. - <br /> FINAL I -- -- <br /> ` SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street, 014 North "C” Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9—•2M 10-52 Revised W-2100 <br />