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APPLICATION FOR SANITATION PERMIT Perini No. <br /> (Complete in Duplicate) Date Issued <br /> ---------- <br /> Application 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 with County Ordinance No. 549, <br /> t031-5- 1J. kt&k-(�J4Y."-K / <br /> JOB ADDRESS AND LOC ATlON___.,;4 1 5 <br /> ........... .7- ----- <br /> --- - ------- <br /> Owner's Name--- <br /> --- <br /> _ ----------- ---------•--- <br /> - --------------------------------- Phone__ <br /> 41a <br /> ,/ 7. <br /> Address..... -- - - --------- .............1Z-- - -------- <br /> Contractor's Name.. <br /> -0- <br /> ---- - ------ ------ -------------------------- -------------------------------------------- Phone---17rr Z jP'�-Zj---7 <br /> Installation will serve: Residence 0 Apartment House Ej Commercial [-I Trailer Court E] Motel El Other ❑ <br /> Number of living units: /---- Number of bedrooms Number of baths Ies—Lot size ........:Ii��6--- <br /> Water Supply: Public system [] Community system El Priva fe AL Depth to Water Table _f�P ff. <br /> Character of soil to a depth of 3 feet; Sand <br /> ] Gravel [-] Sandy Loam F] Clay Loam [:] Clay El Adobe ok, Hardpan E] <br /> Previous Application Made: Yes Ej No ta, ' New Construction: Yes C No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public A sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest -------Distance from foundation---2'0-f-____..Material._. __-- <br /> --------- ------- ----------- <br /> DL No. of compartments------_V--------------- Liquid depth------It-10 <br /> ------------Capacity_:_7—----------- <br /> Disposal Field: Distance from nearest well.... Distance from founclaflon-__Z424--�,--.Distance to nearest lot line__Illp 0 <br /> Number of lines_____________ ----r----w Length of each line---------Y_4:�. i Ti------Width of french---- _#-------- <br /> Type of filter material____/tL_____5.4CDepth of filter material.......... --------Total length___..__ --------- <br /> d -- -------- <br /> Pit: Distance nearest well---114---------Distance from foun4fion---A0-----------Distance to nearest lot line-- <br /> 0� Number. of pits__ ...............Lining materiaJ___,4&_A&AWk.- D ia mete r- DepfN_,.._,v;::4 <br /> Cesspool: Distance .from nearest well-----------------Distance from foundation--__- --- -------Lining material-_---___-________----_.___--- <br /> 0 Size. Diameter-------- ---------------------------Depth-----------------------------------------------------Liquid Capacity--------•. ------------------gals. <br /> Privy: Distance from nearest wel#------------------------------------------------Distance from nearest building----------------------------- - <br /> El Distance to nearest lot line----- --------------------------- <br /> Remodeling and/or repairing (describe):-------------------------------------- ----------------•---------------------------------------- <br /> -------------------------------------I--------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------- ----------------------- - <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - <br /> - <br /> ---------------------------------------------------------------------------------------- <br /> ­----- <br /> I hereby certify that I have prepared this application--and--that--the--work--will--b-e-done--in--accordance--with--San--Joaquin--County <br /> - <br /> ordinances, Stat and rules and regulations of the San Joaquin Local Health District. <br /> c17 <br /> ------- -------1-------S:�--- ------- ----------------------------------------------------- (0 ner and/or Contractor) <br /> By <br /> :------- �- - -----•------------------[Tide} ---------------- <br /> P of 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-------------------------- <br /> ....... ------------------------------------------------------ DATE-__ ------------------------------------------------- <br /> REVIEWED BY " <br /> --------------- ------------------------------------------------------------- DATE--------------- <br /> C= <br /> BUILDING PERMIT ISSUED --------------------------------------------------------- DATE---------- ---------------------------------------- <br /> ------------------------------- -- ------ ---- -- -- ---------------------- <br /> Alterations and/or recommendations--------------------_ <br /> '> . -------*------------- <br /> -----------­----------1--------- .... ...... ------- -- ------------------ <br /> ----------------- <br /> . -------------:-------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> ------------ rl�i ---- --- <br /> ----------------------:f5---------­------------1------------------------------- ---------- -----------\�---------------------------------------------------------------- -------------------------------- <br /> ------------------------------------------------------------ ----*-------------------------------------------------------------------*-------------------- ----------------------------------------*----------- <br /> FINAL INSPECTION BY- - ----- ----- <br /> --- Date <br /> ----------------------- -- -------- ----------------------------- <br /> _ <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 /> 11446 ATWOOD <br />