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W <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued --- <br /> Applica+ion is hereby made to the Son Joaquin Local Health District fora a mit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 54,V-�— <br /> JOB ADDRESS AND LOCATPN---- -- <br /> --- -------1 Fjr-------C <br /> ---- ------ <br /> ---------7`----------*------------------------------------------------------------------- <br /> Owner's Name----------- --------- -- I&--7-A --------------------------------------- -------------------------------------- ...... Phone,/94_ __A_f_4__94 e— <br /> Address__.................. <br /> ---------------------- - --------- ------- -------------------------------------- <br /> Contractor's Name________________ <br /> Installation will serve: Residence 9--"Apartment'House 0 Commercial E] Trailer Court E] Motel 0 Other ❑ <br /> Number of living units-. I--- Number of bedrooms Y-- Number of baths J-. Lot size ------------------- <br /> Water Supply: 'Public system <br /> K—Community system E] Private 0 Depth to Wafer Table _!W. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [:] Sandy Loam 0 Clay Loam [I Clay El Adobe 0--Hardpan 0 <br /> Previous Application Made: Yes E] No 5�New Construction: Yes E] No E] <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 well__A�Distance from fwun ation/d...........Materjal_?C?0�_1R_4Ai;4—---------- <br /> [�tom No. of compartments.._______________S;Ze_a_.1�f1x.1V1?Liquid cl.pth....4-0............. Capacity__, <br /> ��osaField. Distance from nearest well--------_-------Distance from foundation----------------...-Distance to nearest lot line.__-.____________ <br /> Number of lines-----------------------------------Length of each line-------------------------------Width of french,---------------------------------- <br /> r <br /> _1ype OT filter material-------------------------Depth of filter material-----------------------Total length____._-----_______-_____---_._____________ <br /> �,resf well- --------------------Distance from foundation--------------------Distance to nearest lot line__-________-___.. <br /> Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------------_- <br /> C"s ..1. i from <br /> 't, c, <br /> Cesspool: istance fcom nearest well-----------------Distance from foundation-------------_----.Lining material___-___-----_---_ <br /> Size: Diameter------------------------- - ----- ----De th---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_-_-_--_----_-__--__-_____----____________ __D;stance from nearest building----------------------------------------- <br /> ElDistance to nearest lot line--------- ------------------- ---•------------------------------------- --•---_-------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):--- -----------------------------------__--------------------­--1-1------------------------ -------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------- -------------------------- ---------I---------­-- -------- ---------------------­---------------------------------------------------------- --------------------- ----------------------------- <br /> I her tify that I ha e prepared this app a on and that the work will be done in accordance with San Joaquin County <br /> ordinances, S aws, rues and regulations of e San Joaquin th District. <br /> (Signed)_------------------- --- ----------- -- --- ------ ----------- 7 --- --- --- --- ----- -------- - --------------------------------- ontractor) <br /> By: --------------------------- ---------(Title) ------------- <br /> (Plot plan, showing size of lot, location of system i buildings, e c., can be <br /> rela+i t wells, p ace igon'!yie-rrse, side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------------------------------------------------- ----------------------- DATE----------- --- --- <br /> REVIEWEDBY---------------- -----------------------------------------------------I------------------- ----- DATE--------------- ------- <br /> BUILDING PERMIT ISSUED--------------------------------- ------------------------------------------------------------------- DATE-------------------------- <br /> Alterations and/or recommendations-------------------------------------------- --------------------------------------__------------- ------------------------------------- -------------- <br /> ---------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------­­----------------------------------------------- <br /> ------------­- ---------------------------------- -----­--------------------------------­---------------------------------------------------------------------------------- -------------------------------- <br /> ---------------------------------------------------------------- -------­­------ ----- -------- ­------------ ----------- ----- I --------- ---------------------------- ----------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------ ----------- ----------------------------------------------------------------- <br /> FINAL INSPECTION BY:----------V__ A----------------------- 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 145446 AT.... I2-54 <br />