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APPLICATION FOR SANITATION PERMIT Permit No. .---.1-_7..--r-- •--• <br /> (Complete in Duplicate] <br /> 1 Date issued <br /> p�+' n is hereb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Apphca +o y <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-------------- -�- <br /> 1 . C�- _/J•-`- -� .: :f_�---- - -----------L �------------ Phone-_--------------------------------- <br /> Owners Name-------------•'---•----- ------.--.- .,�...�:. <br /> ----------------------------- <br /> Address � :-.. ------------------------ <br /> --------------------------- <br /> Contractor's Namef �.. „ f✓ ° ? ----------- - -----•- Ph nr---------------------------- <br /> - ------•-------- - ------------------ <br /> Installation will serve: Residence ^Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> --------------------------- <br /> Number of living units: ---/---- Number of bedrooms _- --- Number of baths ---4. Lot size -----------ft. <br /> SX•-LU <br /> ivate Depth to Water Table -_. ft, l <br /> Water Supply: Public system � Community system ❑­Pr ❑ P <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ <br /> Previous Application Made: Yes ❑. No [ New Construction. Yes ❑ No R] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S tic Tank: Distance from nearest•well- ---------Distance from foundation-----46_ <br /> ------.Material--------- �------ <br /> s ��x�Liquid depth---------�---- -Capacity Size:- Ca aeit - <br /> No. of compartments-------------- - ---- <br /> Disposal Field- istance from nearest well__- :.----.Distance from foundation--------------------Distance to nearest lot line--------..-_.--_. <br /> Number of lines-•--------=------------------------Length of each`line------------------------•------Width of trench--------------------- <br /> r <br /> ------- •------- <br /> Type of filter material---_-..-.;--__---- -Total length----__--------75- --------- <br /> tenial <br /> Pit: Distance to nearest well:.---- __-----_Di sante from foundation________________.Distance to nearest lot line-.-_--------___-_ <br /> Depth of iter ma <br /> Seepage ... <br /> ❑ Number of pits----------y-,.... .-Lining material----= -----Size: Diameter-----------------------Depth <br /> Cesspool: Distance from nearest well------ ---------Distance from.foundation---.-_._---.-_----.Lining material----_____------_----_---------- ---- <br /> ❑ -------Lquid Capacity- ------------------------- <br /> Size: Diameter--------------------------- ---------Depth-----------_==�------------------_------- igals. <br /> Privy: Distance from nearest well----------.--------------------------------------Distance from nearest building------------------------------------------ <br /> -------------------------------------------------------- <br /> \` <br /> Distance to nearest lot line---.__.=.❑ _---------------------------------- •- - <br /> ---- <br /> Remodeling and/or repairing (describe):------------------_._._ <br /> -------------- ----------------------------•----------------••- <br /> ---------------------- <br /> ----------- <br /> ------------------------------- --- -----------------------------------------I-------------------------------------------------------------- <br /> -------- ---------- ----•-••--•---------••-•---------•------------------------------------------------------------------ <br /> ! hereby certify that,) have prepared�fhis 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 Healfh District. <br /> (Owner and/or Contractor] <br /> �- -(Title)------------------- ----------------------------------------- <br /> Y--( -- -- ----------- ---- -- <br /> 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 /> ------------ <br /> = DATE---------- - / a--c �-------- <br /> REVIEWED BY------------------------------------- ------- ------ -----=---- --------------------------------- <br /> ------------ DATE----------- ------------------- -------------------------- <br /> BUILDING PERMIT ISSUED----------------------- --- --------------------- -------- <br /> DATE - <br /> ations---------------__-.-------_.-----_.-- ------ <br /> -------------------------------------------------------------------- <br /> Alterations and/or recommend - <br /> ,� ----------- ---------- <br /> -------------------------------------------------------------------- <br /> -------------------------------------------------------- -- <br /> FINAL INSPECTION BY---------------- --------------- ----------- • <br /> Date 'fC --•--------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 014 North "C' Streef <br /> f30 South American Street Trac California <br /> Stockton, California Lodi, California Manteca, California y. <br /> ES--9-2M 145446 PTWDOD 12-54 <br />