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IF <br />IS <br />APPLICATION FOR SANITATION PERMIT Permit No.... <br />(Complate in Duplicate) Date Issued.. <br />Appl;ca4iort is hereby made to the San Joaquin Local Health District for a per'nit to construct and install the work herein described, <br />This application is made in compliance with County Ordinance N 549. <br />. ............................ <br />JOB ADDRESS AND LOCATIONV <br />/ _1 Phone- .................................. <br />Owner's Name. <br />Address -.-Y.. .. ...... .. .............................................. ............................... <br />fa tel <br />Contractors Name... i#. ..... ............... <br />Installation will terve. Res;dlenc,% En—Apartment House El Commercial [j Trailer Court 0 Motel [] Gther C3 <br />Number of living units: Number of bedrooms -X- Number of baths Lot size ....`r.........._ _ ...... ..... <br />Water Supply: Public system Community system C1 Private 6-E3epth to Water Table lkff. <br />Character of soil to a depth of 3 feet: Sand Ej Gravel[] Sandy Loam 0 Clay Loam [3 Clay 0 Adobe IT- Hardpan <br />❑ <br />Previous Application Made: Yes C1 No [!�_Now Construction- Yes [] No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sower is avaitabIle, within 200 feet.) <br />Septic nk: Distance from nearest well... ....Distance from foundation ................... Material................................................. <br />No, of compartments. Size ................................ Liquid depth ......... Capacity ....................... <br />P <br />Kpotal Field: Distance from nearest we Distance from foundation... ....... Distance to nearest lot line ... ... . <br />I Number of lines........ Length of each line ...... . /4 ' 4 ­­ Width of .. . . ...... <br />... _.Depth of filter material ....,%... .... Total length ....... .......... <br />Type of filter n - 0 <br />Seepage Pit: Distance to nearest well .... ..... . Distance from foundation................... Distance to nearest lot <br />❑ Nurnoor of pits... Lining material ....... ....... ....... Size: Diameter........,............. Depth - .......................... <br />Cesspool. Distance fromfromnearest well. . ............. Distance from foundation Lining material.................................... <br />S;zo: Diameter....................................................Liquid Capacity. ......... ......... _ .... gals.% <br />0 r. . <br />Privy: Distance from nearest well ... . .. ... .... ....... ... ........ Distance from nearest building ..... .. .. .... .. ...... . ........ <br />ElDistance to nearest lot Vne .... . .. .............. . ................ ............................... .............. ......... ...... ... .... <br />Remodelingand/or repairing (describe):.- .... .......- .. .................. . ..................................... ........................... .................. .... I .... <br />................... ........ I.- ............ .. ...... - ................... __ ............................................ I ...... .... ................. ........ - ....................................... ............ <br />... .......... ............ 1. ..................... I ....................... I ...... . ......................... . ....................... ............................. .......................... <br />........... ­ .......... ............... * .... ...... . ....... **** ...... <br />I hereby, certify that I have prepared this application and that the work will 6e don* in accordance with San Joaquin County <br />ordinances. State laws, and rules and agulation, at the Son Joaquin Local Health District. <br />1;Giw,*P_&wd4w Contractor) <br />Si nod <br />............ <br />......... Arfle) .... <br />By.-._. <br />(Plot plan, showing Size of lot, location of system in relation to wells, buildings, etc., can be pieced on reverse sid a <br />FOR DEPARTMENT USE ONLY <br />,-\PPLICATION ACCEPTED BY <br />PEVIEWED By <br />BUILDING PERMIT ISSUED <br />AlforafloAs and/or recommendations: <br />FINAL INSPECTIO" <br />i to South Amer;cam Street <br />stocklo., C600114 <br />. ......... ......... ........ - <br />............ L ....... <br />f............ <br />Date <br />DATE..... . . C�l AAAA.. , , I .. . ..... <br />DATE-'. .. . ........ ......... <br />DA E... .......... .. <br />.......... <br />.................... <br />SAN JOAQU:N LOCAL HEALTH DISTRICT <br />)00 West 064 S!,saf 112 Sycamore Street 014 N*rlN "C" Street <br />Lodi, Cal;fo­4 Manteca, California Tracy, Califorri;e <br />