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APPLICATION FOR SANITATION PERMIT Permit No. <br /> ' (Complete in Duplicate) '�- <br /> Date Issued <br /> �2't•(�W <br /> Applica-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance wi+h County Ordinance No.1549. <br /> JOB ADDRESS AND LOCATION-------- ) a ----------- C�r_ g. <br /> Owner's Name {�/ ,h .1 .---r Phone <br /> - ---------- - <br /> Address............. : --------------A(6 ----i/.1 1__�_A <br /> - - ­------------------------- ----- -- - ---•- •------------ <br /> Contractor's NamEr----- .....• --- •---- -------------•-------------------- Phone---------------------------------- <br /> Installation will serve: Residence I& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _J_-_ Nur`rtber of bedrooms —6-- Number of baths A- Lot size ------,f <br /> Water Supply: Public system ❑ Community system ❑ Private;Z[. Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobea Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [X_ 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 /> r' S <br /> Septic Tank: Distance from nearest well __-. Distance from f6undation____9�0--------Material-_CRA�,, _--------- r <br /> No. of compartments.- --Size-� <br /> ----Liquid depth- --- --------Capacity------J�-�no--�---- <br /> Disposal Field: Distance from nearest well....4-d._....Distance from foundation______1,�_4_------Distance to nearest lot <br /> 91 Number,of lines-------------/.----- --..._Length of each line---------_R_G?-__I-------.Width of trench-----_7_#!_ � J <br /> r 1 ,� <br /> Type of filter material-_! Depth of filter material---- r .........Total length-------- tl________________________ <br /> r , <br /> Seepage Pit: Distance to nearest well.. ----------Distance from foundation------`%__G______.Distance to nearest lot <br /> p �______-_ -Lining material__C'_L'_.�__W9:1ze: Diameter fir -- Depth_Number of its.---- -- p � ��`1-•------_--- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.__-....____._ ,4�4" <br /> ❑ Size: Diameter--------------------------------------Depth-------------------------------- - ------Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well-------------_---------------------------------._Distance from nearest building----------.----------------------- ____ <br /> ❑ Distance to nearest lot line--------------------------------------------- ----------------------------------- •---- <br /> Rem ling a d/or repairin (descri e): ------lzlw-`-------- ------- ---- `- . <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, ate ws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ----------------------------------------------- ------(Owner and/or Contractor) <br /> ---------- ---- - - <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 R <br /> APPLICATION ACCEPTED BY-) ---------------------- -------------------------------------------------------------- DATE__ <br /> REVIEWEDBY------------------------- ----------------------------------------- -------- --- ------------------------- DATE----3----•---------------------••----•------•------------ <br /> BUILDINGPERMIT ISSUED--------------------- •----------- -•-- --•----------------------------------------------- • DATE..------t^-------------- <br /> Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------- " <br /> ----------------------------------- -- <br /> ---------- ----- -•- -- -°----- ---------------------- ----- . <br /> -----•-•---••---------•------------•-----------•- •---•- <br /> FINAL INSPECTION $Y:.- - (� ----- --------------- Date--- -- <br /> r -------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <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 /> E5-9-2M 145446 ATWCOD 12-54 <br />