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i <br /> 'APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) T �- <br /> Date Issued <br /> A lira{ion is hereby made to the Sd Joaquin Local Health District for a permit to construct and install the work here) <br /> PP Y q p I described. <br /> This application is made in compliance with County Ordinance No. 549. i <br /> s <br /> JOB ADDRESS AND OCATION----- O �` �Zks.� =----•: ---------- i­ <br /> ------------------ <br /> r <br /> Owner's Name .•.:./!�'. -----------------------------;.__�-_....._..... Phon .21 <br /> ------- <br /> Address------------------•----- •-----.._.....T___ •t—.----------------------------•-----------••-•- ------- <br /> Contractor's <br /> •-Contractor's Name.............•---•---- = t ,. --------.......... -••-•---...-•-----•=-••-- Phone •.- 6 O__?_ <br /> Installation will serve: Residence ['Apartment House-L] Commercial ❑ Trailer Court ❑ Motel Q Other 0 <br /> Number of living units: .____ Number of bedrooms .?�< Number of baths /._.. Lot size __7777, le-/-J�_--I---------------- -- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table�{Q ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelardpan Q <br /> Previous Application Made:. Yes ❑ No LAS" New Construction: Yes ❑ No ❑ t ` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank.'or cesspool permitted if public sewer is available within 200 feet.) <br /> ptic T :t Distance from nearest well_.Distance from foundation._ . ..Material__ ____.._.__•----------_____________________ <br /> `jP yr-o'y! No"' of compartments------ -----------------Size............ ............._..-_Liquid depth.----•.....................Capacity--l--•----•----------- <br /> oda ald: Distance from nearest well.:...__..._..._..:Distance from foundation............A-___.Distance to nearest lot line________-____-__ <br /> Number of,lines-----------------------------------Length of each line-----,........................Width of trench---------------------_-•---------- <br /> "`��� Type of filter material________________________D'eptk'of filter material..............:..=....Total length.............._...... <br /> __oe_. <br /> p g Q � - ______._..Distance to nearests�lot lirie_� _.._ <br /> See a e it: Distance to neare t well _. Distance from oundation_ `` O <br /> Number of its.__:r,..__.__.._._.- Linin material_ _ Size: Diameter__ _.__. p F.�- --------------------- <br /> P 9 --- _ ��.�� Depth � <br /> Cesspool: Distance from nearest,well.................Distance from foundation----------------------Lining material-------- -------I_____-______- <br /> ❑ Size: Diameter------------------------------ --------Depth' <br /> ....................................... ........Liquid Capacity gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------=•-------•----••-----•.--•----- <br /> ❑ Distance to nearest lot line-- •-------------•I- . ._ A. ­--------------------------'-- _.._... <br /> Remodeling and/or repairing (describe):-------------------- ... ....-----•--=----------------------------• '="•... - <br /> - <br /> + I- ? r <br /> ••---------------------i-........----.-------.......-------------•---------------------------•---------.......................................................• ................ <br /> r'-^ <br /> I hereby certify that ha 9-prepared this application end-that 41e-work will be done in accordance with San.Joa`uin County <br /> ordinances, State laws.a r es and. re ulation3 f the San Jo u' Local Health District.' , <br /> (Si reed -------- <br /> 9 )------------ = - -------- . •-------•---- `. - Contractory <br /> By----------------------------------------------- =------ ------ <br /> (Plot plan. showing size of lot, location of system in rel ion wells; buildings, etc can be placed•on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- --------------------------------------- ------ DATE------- ------ <br /> REVIEWED BY - :...---•--••. DATE --------------------- <br /> BUILDING PERMIT ISSUED---------------------- ----- --------- ........................................................... .DATE.... I---..............- <br /> .......Alterations and/or. <br /> s /l,........ <br /> .... _� <br /> ----------+......................................._.__......--•..._.-----•-..0..... <br /> ..............................................-----------------------------------i <br /> - ------ -- <br /> --- ............... ------------•-• -._.. <br /> -------------------------------------------------------------------------------------------• -•---------- ----------------------------------••-- .-- ----- <br /> ------------ <br /> ------------------------------------------------------------------ - ...................-----------•--------- --- <br /> FINAL INSPECTION BY:- . -- -a------------------------------ Date..-..- <br /> - - <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, Califorla <br /> I <br /> £S-9-2M Revised W-2100 <br />