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APPLICATION FOR SANITATION PERMIT Permit Na. <br /> Q (Complete in Duplicate) Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to co truct and install t work herein described. I <br /> This application is made in compliance with County Ordinance No. 549. _ 3�p, ��_ <br /> pp <br /> JOB ADDRESS AND _LOCATION------ _ --- oet .--` -- ------ <br /> Phone--------------------•--------------- <br /> � � /---- Q x----- 1 <br /> Owners Name___________ <br /> 5 <br /> Address--------------------- ---- -------- _ <br /> i t�•�` -------- Phone-2s �r ,� <br /> Contractor's Name ` ?0,9,af <br /> f:,!<17 <br /> Installation will serve: Residence Apartment House [I Commercial E] Trailer Court ElMolel d Other ❑ <br /> Number of living units: __._ Number of bedrooms ,Z-" Number of baths __r"" Lot size ." ----- � � <br /> ----- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. <br /> PP y' Y Adobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes E]' No FHA/VA: Yes ❑ Na i <br /> TYPE OF INSTALLATION AND SPECTF{CATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.)r <br /> __.Material--- �f��- ---•- -- -----•--- <br /> Sep is ank: Distance from nearest well Distance from foundation_AV---.----- �, <br /> Capacity- -------- <br /> No. of com artments_____ ---------------Size----47-9f.��------.Liquid depth______,_. ____"- " i <br /> Disp I Field: - Distance from nearest well..._/!;(Q��Distance�from foundation___f�___._."---Distance to nearest lot line r4 <br /> ------- <br /> Number of lines------ """-� --- ----- -----'Length of each -----Width of trench---. _ ----------------- <br /> De th of filter material--_---f-- - --------Total length-------.-{2,. y <br /> 1 <br /> Type of filter maferi_._Ii <br /> W <br /> P "See age Pit: distance to nearest vgekl____ 1�°� =-Distance m founda+ion___ __ Dista'0ce to nearest lot 'sne_.-_�.____----- <br /> �( • - Size: Diameter__ Dep+{n ` <br /> Number of pits------- --------- Lining material- :. / " <br /> m nearest well : Distance:from foundation___________________Lining material--------------------------------------- <br /> Cesspool: Distance frogals. <br /> �. ----Depth_------`'------------- ---------------------------Liquid Capacity---------•-------•----------9 <br /> 1] Size: Diameter------------------ ----- <br /> Privy: Distance from nearest well------------------------------------- <br /> -___.___._Distance from nearest building____:____-_----------------------------- <br /> ---------------__------•--- <br /> Distance to nearest lot line-------=4-=------------------ =------ --------- <br /> f <br /> 1 El <br /> Remodeling and/or repairing (describe)--------------------- <br /> --- <br /> ---- --- f:-1__.--------------------- <br /> } <br /> -- ------------------------------ ------------------ - ` - "----------------- <br /> -------------- <br /> ---------- --------------------------------------------------- - - --- J�`r <br /> . ------------ -----"---------------------------------------------------------------------- <br /> ------------------ - - <br /> Ihereby certify that l have prepared this application and tha ork will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and re ions of the San aquin L 1 Health District. <br /> i } w r ac <br /> _ ��� ner an�/o Contractor) <br /> ---- <br /> - �-- <br /> � (Signed)----•-----------------=------------------ a- s ----- <br /> ------------------ <br /> By: <br /> ��--- <br /> By:--------- --------------------------------------------------- -- �buii;AZ, , <br /> --------------- <br /> (Title) <br /> I (Plot plan, showing size of lot, location of system in relation to wetc. can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> - --------- ---- ---- -- ---------------------------------- <br /> DATE---- = --------------- <br /> APPLICATION ACCEPTED BY----------------------------- - DATE_____ ' "" <br /> REVIEWEDBY----------------------------------------------' - <br /> BUILDING PERMIT ISSUED---- ------ ----- <br /> --- - <br /> - DATE-------------- ------------------- --------------------- , <br /> Alterations and/or recommendations:----------------- __ . <br /> ----------------------- <br /> ------------------------------------------------•--------- - <br /> - ----- -------------- <br /> ------------ <br /> --------------------------- <br /> -.---- - .. <br /> - <br /> -------"-----------------•--------•---------- <br /> FINAL INSPECTION BY------- -- ----- -------- -- - r <br /> SAN JOAQ 1N LOCAL HEALTH DISTRICT <br /> {32 S camore Street 014 Worth "C" Street <br /> E30 South American Street 300 Wast Oak Street Y <br /> Lodi, California Manteca, California Tracy, California <br /> Stockton, California <br /> ES-9---2M . Revised 1.57 F.P.CQ. <br />