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APPLICATION FOR SANITATION PERMIT Permit No. ..._ /_ /.. <br /> /!'.. (Complefe in Duplicate) Date issued ._7!'-_ �.-� <br /> ' <br /> plica io y�i n is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 1 Ap <br /> ! This application is made in compliance with County Ordinance No. 544. <br /> Q� ._ _ <br /> JOB ADDRESS AND LOCATION.-I-------- ,- 12--...----•-.;1 �'? -- ---------- -•--------•--- <br /> ` ---- Phone--------------------------- ------- <br /> Owner's Name....... C_. ._ ---------• [a{"�V e--•------ <br /> i Address----_------ f f--> r- '?a-'4:'t <br /> Phone----------------------------------- <br /> Contractor's Name------ --------- ------------ ---------------------•--- <br /> Installation will serve: Residence ®. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> CF. '.`�C--------.rU---------------------- <br /> Number of living units: ------- Number of bedrooms __ �- Number of baths --j--- tot size ___�__ . <br /> Wafer Supply: Public system Ell Community system ❑ Private,❑ Depth to Water Table . ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe d Hardpan ❑ <br /> Previous Application Made: Yes ❑ No j_ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION ANDS'PECIFiCATIONS: <br /> (No septic tank or cesspoolpermitted if public sewer is available within 200 feet.) <br /> Septic Tank- Distance from f nearest-well-----------------Distance from foundation-------------------Material-----------.-----__.__.------_-..-.-----.._.__._. <br /> ❑ o. of compartments Size-------------------------- Liquid del?t, - Capacity <br /> Disposal - d: Distance from nearest well_./1�1} t_n�3istance from foundation---.+�-� --.---Distance to nearest lot line__��_ . <br /> Number of lines---------- ----i_-.-+-T---------Length of each <br /> line----------- _-�- ---Width of trench----- -a .� ----------------- <br /> Type of filter material-_/ ---_.�,RQepth of filter material------ -- --------rota! length------' _ -;-------------------•---- <br /> '' Seepage Pit: istance to+nearest well;:r__.._. �---Distance from foundation-------------------Distance to nearest lot line-------._---_-___ <br /> N'umber of pits-------------- -------Lining materia4------ -Size: Diameter-----------------------Depth <br /> w ° <br /> I Cesspool: Distance from- nearest welL________________Distance from foundation material_.___________..___._____- - gals. <br /> ❑ Liquid Capacity- ------------- <br /> Privy: <br /> Diameter-=---------- ----------- ----------Depth-------------------------------------------- - -- <br /> _-------------- -----------Distance from nearest building-_-__..._____._______ - <br /> Privy: <br /> Distance from nearest well--------------- ----- ------------------- <br /> ❑ Distance to nearest lot line-f------- -------------------- ----------/-------------------° <br /> Remodeling and/or repairing (describe:__. /t 1 �' �..�7 '�4i." .� ��-1' to13 -/aJ �7 ,'a't/� <br /> 1 �'��-�-e--.---- ' � �-d_ _ =------- = -' -----=�=� =�' <br /> � t .�� - _ Y <br /> 4 f n'r.e <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 and regulations of the San Joaquin Local Health District. <br /> f <br /> ` � h _____________-___--------------------------- <br /> -----------------------------------------(Owner and/or Contractor) <br /> (Signed)......ele.7 , <br /> ------------ ,rr -------(rifle).__.._r�'' "1. <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 /> APPLICATIONACCEPTED BY------------------ - ---- ------ - -- ------------------------------------ DATE------------------------------------------------------------ <br /> REVIEWED BY--------------------------------- -- DATE r I� <br /> BUILDING PERMIT ISSUED------------------------------ <br /> DATE <br /> Alterations and/or recommendations:---------------• - -- ----- ---------•----- •------•------•------•-------------"-- <br /> -------------------------------------------------- ------ <br /> --------------------•------------------------- <br /> •---------------- -------- <br /> FINAL INSPECTION BY:... .. .-�__._ <br /> - Date------. --------------- ----------------- <br /> ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street Tragi California <br /> �� t. <br /> Stockton, California .. Lodi, California Manteca, California Y• <br /> : <br /> ES-9 145446 ATWCUD <br />