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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> gpli'A C <br /> a4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desc d. <br /> This <br /> applicafion is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOC ATICN__NA_AAA_. .------- -- ---- -------- -- <br /> e_x -f----------- -- <br /> ------­--------------- <br /> 11 <br /> 7�1_b <br /> Owner's Name-----------------�1------------- -------r-- ---------- -- ----- -------------------------- --- -------------------------------------------- Phone------------------------------------- <br /> .......... <br /> Address ................. ---------- ---------------------------------- <br /> ---- -------------------------- ------- ----------------------- <br /> r's Name-------- - ---------------- ----- ---- --------- Phone------------------------------------ <br /> I I <br /> Installation will serve: Residence Apartment House Lj Comm tial F urt ❑ Motel [] Other E] <br /> A ] Trailer . o' <br /> Number of living units: ---- Number of bedrooms _.'Number of baths ---I---- Lot size ------------------ <br /> --- ---- - ----- ------ <br /> Water Supply: Public system ❑ Community system E] Private Depth to Wafer Table <br /> Character of soil to a depth of 3 fe6f. Sand [] Gravel El Sandy Loam E] Clay Loam El Clay El AdRbe El Hard an [__1 <br /> Previous Application Made: Yes L] NoK New Construction: Yes No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> '(No septic tank"or cesspool permitted if public svailable within 200 feet.) <br /> X)yer is a <br /> A <br /> Sept' -Tank: Distance from nearest well--. Disfanpyqro dot'o _/4f------- ori I Cape.city---___.- 6.70 <br /> M or' <br /> No. of compartments--------)� id depth----- - --Capa'ity - - - ----- <br /> c <br /> Disposal Distance from founda]pp' nearest lot 4111 e,-,] -I------- <br /> Dis al Field: Distance from nearest well- Distance----- t* i`-_ _.-?. -.Dist ce-to <br /> Length o each line--go <br /> Number of lines........_ --- ---- Len <br /> of f filter material----- Width of french_'_'_._'2--- -------- <br /> Type of filter material__ xve -.Total length------/__9_-n0-------------­--- <br /> Seepage Pit:. Distance to nearest well----------------------Distance from foundation--------------------Disfanc I e to nearest lot line---------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diamefer----------------- -----Depth--------------------------------- <br /> Cesspool: Distance from neorest well-----------------Distance from foundation - -- - ---------- Lining material..---.___--..___-...._.---...__-_------ <br /> Size: Diameter_------------------- -::---Depth-------------------------------------------}----------Liquid Capacity-_:----------------------gals. <br /> Privy-r Distance from nearest well-__............-----------------------------.__Distaince'frorn nearest building-______-_---...._...._.....__._-__--..._. <br /> ❑ Distance <br /> uilding------------------------------------- <br /> Distance to-'nearesf lot line--------------------------------- -------------- ------------------------------------------------------------------------ <br /> T--------- - ------- <br /> 00 <br /> Remodeling alid/or repairing (describe) ------ -- ---- ---------------- --------- --- --- --------- <br /> ---------- -------- ---- ----- ------ -- -------- ---- <br /> --------------------------- <br /> v01--- -------- -- ----- - ------------------------------------------- <br /> ------------------------------------------------------------------------------------------ ----------- ----------------------------------------------------------------------------------------------------­---------------- <br /> I hereby certifythatI have preSared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and <br /> , regulations of the San Joaquin Local Health District. <br /> (Signed)-ov'A ---------------------------------------------------------------------------------------------------------------------(Owner I and/or Contractor) <br /> sr• ---------------------------------------------------------------------------------------------(Tif le)---------------------------­:---------------------------------- <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 /> APPLICATION ACCEPTED BY-------- ----------------------------------------------- DATE----------------­_ • --------------- <br /> '63 <br /> REVIEWED BY------------------------------------ ---------------------------------------------- DATE------- ---- ----- ----- ----.._....--------- <br /> BUILDING PERMIT ISSUED-------------- ;; --------------------------------------------- DATE-------- ------- ------------------- --------------------- <br /> _ kK ?� -7 <br /> Alterations and/or recommendations------ -------------- -------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------I---------------------------------------- ------- ------------------------------------------------------------------------­------------------------------------- <br /> ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------­­------------------ -_-­-------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------- --------- -- -- ----- - -------------- --- ----- -------------------------------------- - M <br /> FINALBY:----------- ------------------ -------- <br /> INSPECTION BY:----------- ----------------------------- ------------- Date--------- ---------------------------------------------- <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 /> ES-9=2m Revised W-2100 <br />