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APPLICATION FOR SANITATION PERMIT Permit NQc_/____��__d_ <br /> (Complete in Duplicate) Date Issued <br /> �;1...�� <br /> - <br /> Application 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 co�mpliafnce7with County Ordinance No. 549. <br /> JOB ADDRESS AN? CATION........... ^: �-- <br /> '' -- --------- v .. . <br /> i4 <br /> ----------------------- �• <br /> Owner s Name: _ . ._._ <br /> e •---•-••-- <br /> Phon <br /> Address.------•='---.���..��,reu,�t�. �r - <br /> Contractor's Name..........................`-�._............................." --------------------- one-------•-----................... <br /> Installlation will serve: "Residence ❑ Apartment House ❑ _Commercial ❑ Trailer Court ❑=- Motel ❑ •Othet-a <br /> Num&er of livin units: .__ Number of baths __ Lot size __---_..D�`'-- <br /> g _.._ Number of bedrooms _� � l <br /> Water Supply: Public system ❑ Community system ❑ Private N Depth to Water Table f47.. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam 4 Clay Loam❑ Clay 0 Adobe❑ Hardpan ❑ O <br /> Previous-Application Made: Yes p No [10 New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool pe"'rN#ed if public sewer,is available within 200 feet.) <br /> 3 a. <br /> Septic Tarr k:,, Distance from nearest well-----PC.._Distance from foundation_.--______ _ <br /> No, of compartments <br /> °^ p •--•- ---Size._.-1-.2-•- �--+..-.Li uid depth--------- p •ty--.rt,.*R.L1� <br /> Disposal Field- Distance from nearest well-----!__G2-..Distance from foundation_._. .• Distance to nearest lat line.... .._.�.__.. <br /> YP <br /> Number of lines.........-__ 1---•----- - Length of each line........16-: -- --------Width of trench__...3.. . <br /> Jc <br /> Typo of filter material_J,/,�._�g.�._W fh of filfor material..._......f.�.......-Total length -------------•---••- <br /> See age it: Distance to nearest well......... ............Distance from foundation...-•-_--__.........Distance to nearest lot line................. <br /> ❑ Number of pits._-------_-•-•-----.Lining material--------------------...Size: Diameter..-------------- Depth-•-•_- d <br /> Cesspool: Distance from nearest well......_..........Distance from foundation--------............Lining material..................................... <br /> ❑ Size: Diameter ...............................Depth..---_-•-• •-..... ................Liquid Capacity....... gals. <br /> a <br /> r'rivy: : Distance from nearest well_._____..-•___________________________••-._-•-, istanes from nearestui mg-------..__-____._____..;- _-_-_-• - { <br /> ❑ Distance to nearest lot line.___._.._.. <br /> Remodeling and/or repairing (describe):.............................. ... <br /> --•------------------•-----•-••-•----••---------'----••---•---•-----•---•-•-••-------•--•-•-•-•-•---.........................................._..---....................................._....................... <br /> I hereby certify that I have pre-••--•--•..... ..............•-----••-........-----•--•-_•-••------....-•-_•--• --•----•-------.......-•---•-•-•------•--•-•-•---•--•---•------•-•-------------------------•----•­ <br /> - ----------------- <br /> pared this application and that the work will be done in accordance with San Joaquin <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. County <br /> (Signed).---- •Ql, ./� ------ _- ---------------(Owner and/or Contractor) <br /> By: -• --- Crrtle) <br /> ------------- - - -- --------------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> r�R DEPARTMENT USE ONLY _. <br /> APPLICATION ACCEPTED BY. y -- Q--' - -•------- DATE. -- �7 <br /> REVIEWED BY -------------- <br /> ------_-•....................•••--. -----•---•-------------- DATE..........-------•--- <br /> -- -=ghJLD1NG PERMIT;,LSSl1.ED__:_ <br /> ... ....... ----------- DATE--- ------------------ s <br /> ••-_-- � <br /> �r yQ Y ' P ..... '?�M1 -a: .. <br /> - - <br /> y P <br /> ...............................-•-•-----...---•--..........---------------------- - <br /> �Z ._._�FINAL INSPECTION BY.._. �f--"' <br /> —----------------- <br /> . i <br /> .......... 4 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street a <br /> ^ Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W2100 <br />