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APPLICATION FOR SANITATION PERMIT Permit No. .__... .. <br /> (Complete in Duplicate) Date Issued $0*�_ <br /> 0177--0Z0-0.5 <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and in tall the ork herein described. <br /> This application is made in compliance with County Ordinance No. 549. �• �P/ <br /> ..5� � DDRE S A�OCA __�-N �r�--��----�l-OY +-�-°---;�t�.-'?" P.S--- -,(,-�7' -�-Y-+l�--�--�'�-'�•�"�c-�°.__------- <br /> JOB A �y _D_ <br /> Owner's Name---------------- ...... ------------------------------------------- Phone------------------------------------ <br /> Address---........ • - '•-----------------------------------------------•---------------------------------•------------------------------------ <br /> Contractor's Namey,h -- -�- - Phone <br /> - <br /> ------------------------- --- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I___ Number of bedrooms J---- Number of baths I--- Lot size _X---Tl6-d--------------------•------- <br /> Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table K-0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ ravel ❑ Sandy Loam Clay Loam ElClay E] Adobe ElHardpan E]Previous Application Made: Yes ElNo New Construction. Yes R-<0 ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �1� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from four dation _� ,�y <br /> Septic ank:- Distance from nearest weh__6v.,- �-__-------------.MateriaL-----------------------------p------------- -•- <br /> No. of compartments------- - Size_ _t _-� 9----------Liquid depth----------------------Capacity----D o-`�,----- <br /> Disposa ield: Distance from nearest weil.�P---------Distance from foundation ____O.Dostance to nearest lot """�� ' <br /> Number of lines__._______.._-_. <br /> Length of each line_-_off,-.�-J ----.Width of trench__p� _ ______________________ <br /> Type of filter material____-7r__,_/I�----Depth of filter material__/-._____-_.__Total length___.f_. �____________________.. <br /> � 4 <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.-----------Distance to nearest lot line--------- <br /> 171 Number of pits------ ------------ --Lining material----------------- ---- Size: Diameter----------------------Depth.--------------------------------) <br /> l <br /> Cesspool: Distance from nearest well________________Distance from foundation.... -......______.Lining material______..._____.__---____._____-.____ <br /> ❑ Size: Diameter----------- ------- ---------Depth_----- -------------------------- - ----------------Liquid Capacity gals. <br /> ----------------------------------Distance from nearest building------------------------------------------ <br /> Privy: Distance from nearest well---------- <br /> ❑ Distance to nearest lot line--------_--------- ------------ ---------•--------------------------------------- ----------------- <br /> l . <br /> Remodeling and/or repairing (describe)---- - ----------------------------- -------------••--------•--------------•-------------•---•--•---- <br /> ---- -•------------------••---------------------- <br /> ----••-----•-----•------------------------------------------ <br /> ----•------------------------------------------•----------•----•----------------...------------------------------------------- ------------ <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, an rules an regulations f the San Joaquin Local Health District. <br /> (Signed). s ----------------------------------------(4wn9r'and/or Contractor) <br /> ------C- - ---------- -- v-sl <br /> - ----------------------- <br /> BY---------- ---------------- Tale ---------------------------------------- <br /> Tot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _ <br /> F It DEPARTMENT-,USE ONLY <br /> APPLICATION ACCEPTED BY... _ . ._. ------ -- ------ rt: =w- -- - <br /> -------------- DATE <br /> REVIEWED BY----------------------------------------------------- - ------------------------- --------------------------------• •------- <br /> DATE <br /> BUILDING PERMIT ISSUED--------------------------------- ----------- <br /> DATE------------------------------------- -•--------------------- <br /> Alterations and/or recommendations:_-------------------=-------- -----------------------------------------------------------•----- <br /> -------------------------------------------------- <br /> -------------------• ------------------------------•----------------------------------------•----------------- <br /> ------•------------- ------------ --------- <br /> --------------------------- <br /> F � 40 <br /> FIN/yL INSPECTION ----- Data._ <br /> ,y SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "G" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E -. <br /> "� E5�9`�2M 14s446-PTW[]oa' 12-54 y <br />