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-� APPLICATION FOR SANITATION PERMIT Permit No. __1_/___(---_j____ <br /> (Complete in Duplicate) /0 <br /> Date Issued <br /> k <br /> Applica�ion is hereby Tmada to the San Joaquin Local Health District for a pe�rrytonstruct d instal the her scribed. <br /> This application is made in compliance with County Ordinance No: 549.. C f(pp 3 J <br /> ID <br /> JOB ADDRESS AND LOCATION------------------ ----- <br /> Ownear's Name........... <br /> � J <br /> --- '---------- ---------------------- -------------------------------------- Phone-------------------------------•--•- <br /> �r--- --- ----- ��• <br /> --• --------•----------- <br /> Contractor's Namer` ------------------------------- ---­---------------- Phone me � d-� <br /> Installation will serve: : Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: /____ Number of bedrooms __-3- Number of bathsf_..._ Lot size ____���------------------------___--- -Y <br /> Water Supply: Public,`system F-1Community system [-] Private ;R, Depth to Water:Tablezgv ft. <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 @S�_ New Construction: Yes WL No ❑ <br /> TYPE'OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest we�l___�_Q.- Distance from foundation__- Material___C_ <br /> No.,of compartments--___- �o___ _ Li uid .de th_.._ _ r �' ----_-- <br /> -: Size.. q }? ------ Capacity <br /> Dis --------- <br /> Disposal Field: Distance from nearest well____�s.d_._._Distance from foundation__ <br /> P -,O-e`._..Distance to nearest lot line_.,_ -------- <br /> Number of lines__________ ______ Length of each line... -------Width of trench-__r -4;P_--/ - -_ <br /> # Type of filter matenal___1 -___- R-Depth of filter material__eB__-___-5igotal length_-_-_-___`' `�--------------- <br /> p g - <br /> See a ePit: Distance to nearest well__{.�C3___ _-_Distance from foundation_____��_-: Distance nearest lot line_- --- <br /> __� <br /> Dumber of pits---_`-___-.-_-.__Lining material__ ie Diameter___ Depth._-_�,&----------------- ' <br /> Cesspool: _ Distance from nearest well------------------Distance from foundation---------------__- Lining material_____.-_-----,______________________- <br /> ❑ Size: Diameter----"--------------=------- ------Depth---------:---------------------------- --------.-----Liquid Capacity....=-----------------------gals <br /> . <br /> Privy: Distance from nearest well---___ _____________________-______.._Distance from nearest building---------------------------------- <br /> --_- . . <br /> ❑ "•Distance to nearest lot line.-"-Y--- 4----- --- ----------------->-,--- ------------ <br /> fes'' <br /> Remodeling and/or repairing (describe)______________ -1D <br /> --------•------------.------------------------------------ <br /> -=------------------------------------•-••--•--•----•--------------------------------------------------------- - - <br /> ---------`--------------- ------ ---- <br /> r <br /> I hereby certify that I have prepared this application and that the work will be done.in accordance with San Joaquin County <br /> ordinances, State , and rules 'and regulations of the San Joaquin Local.Health District. <br /> , <br /> (Sned -- ------=- --- --- <br /> - -- ---- ---- -(Owner and/or Contractor) <br /> -- •-- - ------------------•-(Title)--- "'' c <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-------------------------- <br /> --" DATE--.___-- <br /> -=-------•---- <br /> REVIEWEDBY--------- ------------------------------- -- -- -- ---------------------------------------------------------- DATE----------------`'------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------- _, ----------------------------•-------------•-------_--•---- DATE------ J <br /> Alterations and/or recommendations------------------ -- ------------:---------------•-•F•-------------- ------ <br /> IQ-�, -• " ,rte._. _ Q74_&r, wAe..-4'�d--------------------- -----=-=-----------------------------------------------------•- ---=-=- ------- <br /> - -- '---- off'------------------------ --- ----------"--------------------------------------------------------- <br /> ---------------------------------------------------------------- <br /> FINAL INSPECTION BY:..-. Date-------- <br /> / ----i- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stock+on, California Lodi, California Manteca, California Tracy, California <br />{ ES-9 [asaae a'rwggq <br /> L - � <br />