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d APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> (Complete in Duplicate) f -- <br /> �; � Date Issued <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. �s <br /> JOB ADDRESS AND LOCATION........7,.32-- A1®_........ .e ST-----r----� • -------------------------------- <br /> Owner's Name-------------•--•-----..-------•--------.-#4-14.1.__...--- - - -- ------------------------ - Phone_tr r RIF/ --------- <br /> Address--------------------------------------------------- 'gym------- -� •-•-----------------••------------•----------.--••----------------•---.--. <br /> Contractor's Name--------------•--------_-----f t#.� ........ <br /> ------------------------------------------------------------ Phone-- -.?- tt 1-_&.?.7----- <br /> Installation will serve: Residence` Apartment House ❑. gCommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..:-__ Number of bedrooms AA00' Number of baths --- Lot size <br /> Water Supply: Public systemCommunity system ElPrivate ❑ Depth to Water Table _V_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay am ❑ Clay ❑ Adobe - Hardpan El <br /> Previous Application Made: Yes E] No New Construction: Yes El No El ., , <br /> I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: � { <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> tic Ta :� a ' Distance from nearest well------------- Distance from foundation--------------------Material_____________:________________________ <br /> No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity-••-------------- <br /> Dist <br /> nce from <br /> Distance from <br /> al Fiel Numaberr of linesearest well----------------Length of each line ation----------.---------Widthcoftfrench est lot line----------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length--------------------------------___._____ <br /> Seepa a _Pit: Distance to nearest well__��? _____Distant n tion_.,�W.____-.DistancQ o nearest lot line__€_______ Q 1 <br /> Number of pits...... Linin material_ 4e: Diameter......4V43 --__De tn___AR�___________________ 1'r <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- �� <br /> ❑ Size: Diameter--- ------------- ----- ----- Depth--------------------------------------------- -----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building-______--___-.__-___________._.__..______. 1 <br /> ❑ Distance to nearest lot lire------------------------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe)=------------------------------------------------•---•----.------------------------------------= -------------------------------------------------•-- i <br /> ---------------------------------------------------------------------------------------------------------------------------------rr---...--------------------------------------------------------------------------------------- <br /> _______ _____________________»........___.--- _________________3____________________ .------------------------------------.._________________...____ i <br /> I hereby certify that I have p epare this applic on an at the wo will be done in accordance with San Joaquin County <br /> ordinances, a laws, and rules d re ulations of ie San aquin Local Health District. > <br /> a <br /> (Signed) --- ----- ----- -- ------- ------ - - ---------- ------------- -----�N..`----- C ntractor) <br /> J44J <br /> By-- -- - -- - --------------- -- --- ----------------------------------------------------------------------------------(Title)_ <br /> ---- - - ----------------- <br /> (Plot plan s wing size of lot. Iota+ n f system in relation to wells, buildings, etc., can be aced on reverse side). ; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--_ - DATE <br /> _V <br /> BY----------------------------- ----------------------------------------------=----------------------------- DATE--- ------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ -----------•---------------------------------- <br /> Alterations and/or recommendations------------------=----------------------------------------------------------------------------------------- --------------------------------•-••---------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------- -------------------- -------------------------------------------------------------------- ---- ------------------------------------- <br /> -_' <br /> FINAL INSPECTION BY:----------- - ------------ ---- -- ------- Date-- l <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 io-52 Revised'W-2100 <br />