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Permit No. _-- <br /> '. APPLICATION FOR SANITATION PERMIT -�'-�--��--- <br /> (Complete in Duplicate) <br /> Date Issued <br /> plica{ioK'sereby made to the San Joaquin Local Health District for a permit to <br /> construct and install the work herein described. <br /> C1,111 <br /> is application is made in compliance with County Ordinance No. 549. <br /> ��� -------------------------------•--•---•-------------------- -------------•------ --- <br /> P <br /> -- <br /> J08 ADDRESS AND LOCATION_..._2 b ------- --� ------- <br /> ------------- <br /> --------------------------...----- --------- Phone <br /> Z <br /> Owner s Name------------------------- <br /> ------------------- <br /> --------------------------------------- -...---- <br /> ' Address------- ---------••-----------------------------------•------------------•------------------------------------------- --------------------- <br /> --------------- ---�= -- <br /> F Contractor's Nam f_ ] ---------------- Phone`i ? <br /> 3 3 <br /> I <br /> i _. <br /> - ----- -------------------- <br /> Installation will serve: Residence IK--Apartment House ❑ Commercial ❑ Trailer Court ❑ JNofel ❑j then ❑ <br /> Number of livingunits: _ .__` Number of bedrooms _ -._ Number of baths __j---- Lot size __-��-a_.__` ___L----- ----------------------------- <br /> Water Supply: Public system Community system [IPrivate ❑ Depth to Water Tableirft. <br /> Character of soil to a depth of 3 feet: Sand Gravel F1 Sandy Loam Clay Loam E) Clay F] Adobe Hardpan ❑ <br /> t Previous Application Made: Yes ❑ No' 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 /> 4 <br /> Septic.TSO Distance from nearest well-------------- --Distance from foundation--------------------Material-------------------.____---_-..._---_-__________- <br /> t No. f compartments--------------------------Size------------------------•-------Liquid depth_-------------------------Capacity--------------------•-- <br /> Field: Di Oce from nearest well.................Distance from foundation .____-.Distance to nearest lot line------- <br /> Disposal <br /> ,er o lines-----------------�- . ..---Length of each line----____- S� -Width of trench-------_-f_- -- --- • <br /> r--� <br /> T <br /> filter material____ Depth of filter material_--_ ?al length__: ____________ __ ______ <br /> See a st: Distance p g istance to nearest well_.___a�'�._____Distance from f undation ____:. <br /> Q�stance to nearest I <br /> ------------ <br /> Number of pits._I-----------------Lining material_ -- _"d <br /> e: Diameter_ �_ �`Qeptn____ ._____ _____/ � <br /> I Cesspool: Distance from nearest well._.____________-Distance from oundation.____-_____.___--..Lining material____ _____________.____..___._____ <br /> ❑ Size: Diameter- ------------------------- - ------Depth--------------------- -.---------------------- ---- Liquid Capacity gals. <br /> ... _Distance from nearest building Q <br /> privy: Distance from nearest well ------ --------- g <br /> ❑ Distance to nearest lot line----- --------------------------------------------------------------------- ----------------- ----Q--t-4------------- ----------------- <br /> Remodeling and/or repairing (describe):---- ----------------- <br /> - --- -- •----------•- <br /> -----------------------------------------------------------------------------------------------------------:1......------_---------------=------------------------------ \ <br /> ! hereby certify tha# 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules'and regulations of the San Joaquin Local Health District. <br /> 1 {Owner and/or Contr`ector) <br /> r (Signed _ ------------------- ------ ---------- -------- -----------••--------------------- <br /> -- ------------- - ------------ <br /> BY=--------- --- ----- ------1n�.J!-�----- --------------------- ------------------------------------- -(Title)---- ---I'S <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reversetfide). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - DATE=- <br /> REVIEWED BY------------------------ DATE <br /> BUILDING PERMIT ISSUED--------- ------------------------------- ---- <br /> DATE. <br /> Alterations and/or recom n tion • - --------- ----- ------ ------�... --------- ------------•----------- <br /> r <br /> U ---- --------- .......... rvly <br /> ---- ---------- J. <br /> ---- ------•----- <br /> . <br /> L,,e� <br /> --------�------- <br /> g+------------------------------ - _-__.__r` J <br /> tx LS <br /> . <br /> FINAL INSPECTION BY:1-- -- -=----- ------- ------- f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r <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-9-2M 145446 ATW[]C D 12-54 l <br /> r L <br />