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E <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> fiP <br /> Applica"ion 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. <br /> IrS4-7- 14 , -0 -------------------------------------------I---------------------------------- <br /> JOB ADDRESS AND LOCAWN--=---------------------- -- --------- ----------- <br /> Owner's Name-------- )�;Ir ------ .... Phone------------ -------------------- <br /> ... .... ---- <br /> Address............. -------------------------------------------------------- <br /> ------------- Phone-------------------------------i3 <br /> Contractor's Name-----------X--- -- <br /> Installation will serve: Residence ne—XI-Partment House ❑ Commercial ❑ Trailer Court E] Motel [] Other El <br /> Number of living units: ­/--- Number of bedrooms -4- Number of baths --/-- Lot size A!�- --------------------- <br /> Water Supply: Public system M-ltommunity system [I Private E] Depth to Water Table --T <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel 0 Sandy Loam E] Clay Loam E] Clay F] Adobe� ardpan ❑ <br /> Previous Application Made: Yes E] No � New Construction: Yes [-] No R� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool.permitted if public sewer is available within 200 feet.) <br /> Sept- Tank: Distance from nearest well--,_-_-________Distance from foundation--------------------Material--------------------------------------------- <br /> No. of compartments------------------------- Size--•-----------------------------Liquid depth------------ -- ----------Capacity------------- ---------- <br /> D' 'fFiild: Distance from nearest well_-_--_.____----_-----------D'sfance from foundation_-------------------Distance to nearest lot line----------------- <br /> L ------------------------------ <br /> Number of lines-------------- ------ -------------Length of each line--------------------------- of french - <br /> Type of filter material---- --------------------Depth of filter material_------------- #......Total length----------------__-_------------------ <br /> r -- <br /> ? & /99 e <br /> fro ---------Distance to nearest lot line-_ <br /> f <br /> . ...... is ance r u ation-­/�e- -------- ------ <br /> Seepage Pit: Distance to nearest well-. <br /> ize: Diameter <br /> Number of pits.1 /--------------Lining material_ - --------Depth........�? --------- -- <br /> ..............................L_ <br /> Cesspool: Distance from nearest weil-----------------Distance from foundaf;on . .................Lining material <br /> Size: Diameter--= ... -------------------------------- ------------------- <br /> -------------------------------Dep�k3 Liquid Capacity----------------------------gals. <br /> Privy,.. Distance from nearest -----------------------------------------Distance from nearest building-__._-.-__-__:___-__-______--------------- <br /> I --------- .... ----------------------------------------- - ---------; <br /> El' Distance to nearest lot line-------------------------------- -------------- <br /> Remodeling and/or repairing (describe):------_----: r. ------ -----------------------------------........-------- <br /> ----------------­-----­--------------------------------I-------------------------------------------------------------------------------------------- ------- -------------------------------­----­---------------- <br /> ------------------------------I------------------- -----------t-1--------------------------------------------------------------------------------------------------------------------------------------------------------11--­ <br /> -------------------------------------------------------------------------------------------------------------------------------------- --------------I-------------------------------------------------------------------------- <br /> I hereby cerfify:fhaf I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rWes and regulalions of the San Joaquin Lo Health District. <br /> (Signed)----------------------A-k---- Ore.�_- ------ --- -- -- -- ------ -------- <br /> ---------------- <br /> ---- -- -2-- ----------- ---------------------(Title)----- <br /> By:---------------------------------------- - - <br /> (Plot plan, showing size of lot, location sysf em.in.relation to wells, buildings, efc., can be placed on rever side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> BY--'�----­------- - --------- - -------------------------- ------ DATE" ------------------ ---------------------------------------------------- <br /> - <br /> REVIEWED BY---------------------------- -- - - DATE- ----------------------- <br /> -- <br /> BUILDINGPERMIT ISSUED------------------I------------------------------------------ --------------------------------------- DATE-------s -_----------------------:79;7�---------------------------------------- <br /> ------------------ <br /> Alter fion, pd/�r recomm nd ti ns:------- ------------ --------------- <br /> ---------------------------------------- ------------------------------------------------------ <br /> 4cZqa. -------------------------------------------- <br /> a Y-0-4- . ........&L----I ----------------------------------------------- -------------------------- - <br /> ..... ------r ­ T -- - - -------- E <br /> . ..........I-------------------------------- --- ----- --------------------- ----------------------------------------------------------------------- --------------------------------- <br /> ....5 <br /> ------------- <br /> 0 ----------------- --------------- ---------------------------------------------------- -------------------- -------------------- --------------- --------------- <br /> ----------------- ----­---------------------­----------- <br /> ----------------------------- ---------------------------- ----------------­­-- ---- -------- --------------------------------------------- - ----------------------------------------------------------- -------I------ <br /> FI NAL INSPECTION BY--- - -�- -sls---------1----------------------------- Date­J,-. <br /> ------ ---. ............ ------- --------------- ---------------------- <br /> :j <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Syearnore Street 814 North "C" Street <br /> Sfock+on, California Lodi, California Manteca, California Tracy, California <br /> ES-9 14 5,446 ATWC130 <br />