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�I1 � �/ <br />APPLICATION FOR SANITATION PERMIT Permit No. •-.W.J 1 3 <br />` (Complete in Duplicate) <br />' Date Issued ---- --- f-1........ <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 Ordinanc o. 549. <br />JOB ADDRESS AN CAT ON___-_��-_ <br />------------------ --------------------------------------------- <br />Owner's Name ....... 1 - �----------------•----•-•--------------- -- .............................. ...... Phonel_3/0.4�/31 <br />Address-----...- --•-- - -- ---- ---- <br />;= <------------------------------------------------------------------------------------------------------ <br />Contractor's Name... `�¢"...------------"--------------- Phone_ lY6.. -r. C / <br />Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [jOther ❑ <br />Number of living units: _/-.. Number of bedrooms _/---Y //_-_ Number of baths ./._- Lot size --- -,y...X 45r_411;�___--................ <br />Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table'y..7 ft. <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' Hardpan ❑ <br />Previous Application. Made: Yes ❑ No New Construction: Yes ❑ No 19 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic TDistance from nearest well. Distance from foundation ... --- ..._.__ <br />fl� Material................................... <br />aV <br />............ <br />....._......_._..___ -.-------- of comp...1.............. ..-....qp...Capacity <br />Disposal Field: Distance from nearest `dell.._ Distance from foundation_ --.._....Distance to nearest lot line --- S_.�.__. <br />�f <br />Number of lines .-..--..___/-------------------- Length of each line__._.._... -,,j6. ------....Width of trench-----z� ..� <br />- - - - ----------------------- <br />Type of filter material__S J.& . .. Depth of filter mat erial-_-.._-_--)-Ir ' - '----Total length.= .... 3,d-------------------­------- <br />Seepage <br />---.-.•.....................Seepage Pit: Distance to nearest well__ -------------------- Distance from foundation ............. .......Distance to nearest lot line ----------------- <br />❑ Number of pits ...................... Lining material--- ..._____.Size: Diameter ----------------------- Depth... ................................. <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):..,-,.,,,. __.•- •.•• .3l,�__�-_ <br />r <br />- ---% = � - -- ----- , <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 />---------�,---lNiG4 -- `-- - �alth District. <br />ordinances, State laws, and rules and regulations o�- San Joaquin Local H,., . <br />(Signed) _..-- ------ (Ow rand/or Contractor) <br />By:------------------------------------------------------------------------------------------------- •................... -------------(Title)------- -- ----- <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY v 5 ---------------------- <br />DATE... �..Sr --5'--------------- <br />REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE <br />------------------------- <br />UILDING PERMIT ISSUED ------------------------------------------------------------------------------------- <br />•................ DATE <br />Alterations and/or recommendations: ---------------------------------- <br />---- <br />. <br />-----------------------------••-----•---------------------------------------------------------- ------------ ------------------------------------------------------------------------ <br />-----------"--------------•-•------.--------------- ----------......------------------ ------ -----•------------------------------------------------------------------------------ <br />.--------•-------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------- <br />---------------................. -............... ------------ -•----------------------------------- -------- ---------------------------------------------------------- <br />A <br />------------------------- <br />- ------------------------- <br />a <br />FINAL INSPECTION BY% ...... <br />-••--- ............ �:�.�r/�'� - - Date---------------------- ------------ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES -4-2M ; Revised W-2100 <br />31 <br />