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0 gyp,- - 3ti f-A- . e ( � ala u 0 <br /> (� -c.�a-�z, dC��4-fir �5!' /Y <br /> r <br /> IPPLICATION FOR SANITATION PERMIT Permit No. .___$.P_!_.5=..... I <br /> (Complete in Duplicate) Date Issued .... <br /> 7 <br /> *Appllca4ion is hereby made to ther San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compli ith County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION ... " ..` .. .. <br /> Owner's Name ...u......_ - Phone.. ' .. <br /> .... <br /> Address:--� �''?� �?(�._. '7 '� -------------•---....-••._._................................................ <br /> e.. -_. .�.....-----•..._... <br /> Contractor's Nam _ ..... �""�-"- --__-_.`................... Phone•f+0_..��' . <br /> x.._.. <br /> Installation will serve: Residence 521"Apartment,House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___I.._. Number of bedrooms __ -_. Number of baths ._..i__. Lot size ---- <br /> G?.�4'-$-.;•-•••-•----••----...... <br /> Water Supply: Public system ❑ " Community system ❑ Private Depth to Water Table L_ ffi. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam❑ Clay.Loam E] Clay❑ Adobeff"Hardpan ❑ <br /> Previous Application Made: Yes ❑ No W, New Construction: Yes-s�rNo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic�,xank: Distance from nearest well..•...............Distance from foundation._.__..._.___.__._..Material......... <br /> ._..___._..___......____._______.___.... <br /> No. of compartments..........................Size--------------------------------Liquid depth-----.....................Capacity.............. -•---- <br /> Disposal F1 Id: Distance from nearest well................Distance from foundation....................Distance to nearest lot line................. <br /> Number of lines--------- _----_---.-----Length of each line..........---•----'..........Width of trench----------------------•------------ <br /> Type of filter material.........................Depth of filter material----------------...-•_..Total length..._----.-----.- .._-.--------. <br /> Seepage it: Distance to nearest well._.-.....____.._.Distan from foundation_ !Y� .�.!�-.Di t ,i�a to nearest lot lir e�. ..._._..___ N y <br /> Number of pits.._.!----------------Lining material Diamer------- <br /> Depth----- _._..._.__.....__.. <br /> Distance from nearest well.................Distance from oundation--------............Lining material__- _....__-.-____-______----._._. ('f� <br /> ecesspool: <br /> ❑ Size: Diameter---••-------------------------------- Depth_-._._.__-.-..-_ -- ....._Liquid Capacity_..........................gals. <br /> Privy: Distance from nearest well....... ......__------- .............Distance from nearest building........._................................ <br /> ❑ Distance to nearest lot line................................................ ._...........__---..................................................................... <br /> Remodelin and/or repairing (describe):.... .............._.,-. !�`��• � ' <br /> �J --------- <br /> _-__-_------ ------- <br /> •-•---------------•------_--_.---------.----•---•---------•----__--_----•----•---_-_-_------_._--------•----------- .... - ---_-.__.----•--•-------------•-..__._._.......__..__ { <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> 1 �,,,,�,., ' -_•----_.__.(Owner and/or Contractor) <br /> (Signed).__ ..................•--------------............. • <br /> ................... <br /> IT e) <br /> P (Plot plan,showings of lot, locati of system in relation to wells, buildings, eta, can be placed on &verse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..-........................ o- . .. ---_. .- - •----------- .-------._._-_ DATE.-- ._._....._.._._...---_.--- <br /> REVIEWED BY_--_--------------- -------------------- -- DATE__..._-'�. = .. <br /> ..--•••---•••---_... <br /> BUILDINGPERMIT ISSUED-----------------------_---- - --------- ----••-- DATE..............--••-----------------------------•---•-•---- <br /> Alterations and/or recommendations:..._................. ........................................................._--•---------•----._-.------.__...___•.................. <br /> i ............•-........••---•--•-----...--•--...._.----•--•------•----•--••....................... <br /> .................•------------..__...........-•- <br /> ...._...-•--••..............:................................................•------....__._.....---......_...-......_._..._._..-----•--•---...._...._...............-•................................... <br /> ...._------•----•••---•-----•-•---•--•--•-•--------•----•-• ..... I <br /> /� Date./!1 .7 �.......... ............. .............................. r <br /> FINAL INSPECTION SY:.�!�tr: -•••------•• <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> IJ E <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C"Sfree+ <br /> Stockton, California Lodi, California Man+eca, California Tracy, California <br /> 1 ELi--•9-2M 145446 wTW�00 1"L-'S� <br /> it �_ <br />