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APPLICATION FOR SANITATION PERMIT Permit No.-.r5_4-5 <br /> ` (Complete in Duplicate) Date Issued . <br /> Applic&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�C,ounty Ordinance No 549 , <br /> JOB ADDRESS AND CAT ON.,/r Z#' (fir ^ z r .,:'}. rEs'+� 'R�4 +f-?'.a _. - . . <br /> J �... <br /> Owner's Name --- ::�{�2:_E.4.` .... ..... .._ .---------------------------_ Phone,/Q... ' 't <br /> Address..,. a3 <br /> (; -...... -------------- <br /> Contractor's Name.......r„Y k.,f:..:. c'. er,.,,-.-..xy.... :£.-` - --- -------------------------------- - Phone %�..:. . <br /> .----- c. .... . <br /> Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [f �Qther ❑ <br /> Number of livingunits: ...,._..`Number of bedrooms <br /> �.-.. Number of baths oe.._ Lot size .- .;�`--/:y,r...-'.:... .....................--....-- <br /> Water Supply: Public system ❑ Community system ❑ private <br /> Jkr Depth to Water Table J 2 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ Nos� New Construction: Ye� No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Task: Distance from nearest well. ... ...- . ...Distance from foundation. .... ......Material......... ._.----_....... ..... <br /> ' No. of compartments_..._.. - Size .. ........ ...... ....Liquid depth . -- - Capacity............... <br /> _..\Dsposal,Fie)d: 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 /> x � <br /> See e Pit: Distance to nearest well � ....----Distanceom,foodafion..���---_.....Diistance to nearest]of line - <br /> Number of pits_.l.-.._..._.__.Lining mater �.yrt_;'t> .-_..Size: Diameter._.__,.?._.----------Depth.._...•&,&........ <br /> ... <br /> Cesspool: Distance from nearest well----------.----Distance from foundation-----------........Lining material..............___._- <br /> ❑ Size: Diameter--------------------- -_ . .--_Depth....... --------___--------------.------------Liquid Capacity........ ...............gals. <br /> Privy: Distance from nearest well----- ..___.____---------__........_.Distance from nearest building-------------_;_._...___._.__. <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe): -�:E'-' .f -ice ,� 'r_-. :;-._�,��' -�.,;,,• < <br /> ... .----- ----------------------------------.---- -- rr' .. .... ..... .....•.......................... ... ..... <br /> -----------..._...-- --------------------------------- ------------------'----.........-------- -`----------------........................—...-`---------------------- '- <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, Sfe laws, andsules.and regulations of the San Joaquin Local Health District. <br /> (Signed....... ,r: r .� _' .... . _-- . ................ - ---(Owner and/or Contractor) <br /> ..- <br /> By:... <br /> (Plot plan, showing size lot, location of system in relation to wells, buildings, eta, can be `"ed-on rave so si;I�. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... -- --------------------------__.................f.�. ---- -............- DATE--------. . ..� <br /> REVIEWEDBY................--._._._..........._._............_........ -...._...--.L/5 ... --- ...... DATE..................-................... - <br /> BUILDINGPERMIT ISSUED...-.......---------------------------------------------------------------.......................... DATE. ...--------------------------........--•--- <br /> Alterations and/or recommendations:---------------------------------------- -----....................................... ........... - --............................... <br /> .............................................-------...................._...--- ....... -----------------_-----------------..... -------------------------- ----------..-----...---- <br /> - -- ---......---..............._. -- - . .......------............. ...................................................................................................-- <br /> ...----....._.......- .._........................................................................ -------...................... -........................-...--.....--.................................. <br /> ........-----------------..... ................................. ....._....__... <br /> FINAL INSPECTION BY:..._..._........._._....v/� G� L � f G <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sheet 300 Wes+ Oak Sfreet 132 Sycamore Street 814 North "C" Sfreet <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M I Revised W-2100 <br />