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APPLICATION FOR SANITATION PERMIT Permit No. .3_1$__7i�_:- <br /> ,r (Complete in Duplicate) <br /> f �! Date Issued _____ __ __5-3 <br /> vU Application is hereby made to the San Joaquin Locaf Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance N"14 <br /> 7--- sp, . <br /> JOB ADDRESS AND LOCATI N-------- - ---- - - ------�-------------------------------------------------------- - <br /> Owner's Name--------- ------ -------- ------------------- Phone------------------------------------ <br /> Address ,� --------------------------- J u --------------------------------------------------------- <br /> ----- <br /> --=' <br /> -- ----------- ------------------- -------------- ---- --- ---------------- <br /> " /:o <br /> ------- - <br /> 3 Contractor's Name-------- - -- ---ID-4--- - all-- ' ' ------------ Phone--4" <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ff i -�7 <br /> Number of living units: ___l____ Number of bedrooms _4 Number of baths - __- .Lot size _--___,,C_- _45X-____-__ f_______________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table I_It. <br /> Character•of soil to a depth of 3 feet: Sand❑ �Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ jI No New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta Distance from nearest wellA/0_46 Distance from foundation-J-4--------- <br /> EJO No. of compartments--,O -------- -------5i e_--_ _ / _Liquid depth ?______Capacity____, <br /> Disposal,Field: Distance from nearest we].A/_�"'4'���Esfance from foundation_- s----------Distance to nearest lot line--- <br /> Number <br /> -- __-.-• <br /> ❑(.� Num er of lines-_-��� 'iN�--_"____Length of each line___ { ° __ '� <br /> b -- g 4-- width of french-----.--? <br /> of filter materialsri__ _ "�__Depth of filter material___-/_,__"'------Total. length---- �f + <br /> r �l <br /> Seepage P' . Distance to nearest wellfl1DDistance from fou dation----'�_�___.Distance to nearest lot line--- <br /> I Number o£ pits_ __________Lining material___#kZw'. .Size: Diameter_____y,,,a__'___-__-____-Depth_____aF _�_____.____ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining <br /> material_ <br /> _Y______________________________ <br /> ____- <br /> Size: Diameter----___-------- -De Depth________________ ____Li Liquid Capacity -9alsEl <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line---- -------------------------- ---------------------------------- --------------------------------------------- <br /> Remodeling and/or repairing (describe) - --- ----- --------- --` ----- / ----------- <br /> ------------------------------------------------------------- - ---- - - -------- ---- - ---- --- � --------------- <br /> - - - � ��-- -------------------------- - •-------------------. <br /> ------------------------------------------------------"--------------------------------------------------------------------------------•------•------------------------------------------------------------- - -------------- <br /> 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 /> (Signed)--------- ¢ c (O n w and/or Oontractorl <br /> BY� --------------------------------------------------------------------(Title) <br /> -- - --------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 4 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -- -- --------------------------------------V'16--------------------------------- DATE---------------- �- <br /> REVIEWEDBY-------------------------------------- ----------------------------------------------------------- DATE-------- ------- -------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------- '-------------------------- ---------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:-------'---------------------------------------------------------------------------------------------•-------------------•---------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ---------------------•- <br /> ------------------------------------------------------ ------------------------------------------------- - ------------__-._---- ------------------------------------------------------------ <br /> ---------- <br /> ---------------------------------- -- <br /> -----------------------------------------------------------•-•--------------------------------------------- ----------------------- ----- ---- ------­­ -------------------------------•--------------- <br /> i <br /> e �• <br /> FINAL INSPECTION BY:___________________________ <br /> Date <br /> Cf --- /--- ----------------------------------------------------------- <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 /> E5-9-2M 8-51 Revised W-2100 <br />