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1 APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> �Applica4ion rDate Issued ---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 Ordinance No. 549, <br /> JOB ADDRESS AND i <br /> ' � -_ _ <br /> € <br /> -10 -v/ <br /> � <br /> ----Owners Name_____ � ------------------------ <br /> Address <br /> flt(C-�----f--�-- <br /> -----------------•------------ <br /> rrA- _ one <br /> Address_-•--------_-- --- <br /> ---------------­-----:------------------1*-------------------- -----------------11-------- <br /> Contractor's Name.--- � <br /> Phone- --Z-``Z -!e: 7 <br /> Ins#allation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___ Number of bedrooms .__. Number of baths ----)__ 'Lot size _____� � <br /> Water "Public --- -------•------•----------- <br /> Supply: jsysfem� Conimunify ssystem ❑ Private ❑ Depth to Water Table ft.. <br /> Character of soil to a depth-of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam.[] Clay [_1 Adobe[ Hardpan [] <br /> Previous ApplicationMade: Yes El [�- 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 Tank: Distance from°nearest well__ d�c _ " <br /> Av <br /> f-Brstance from fdundation__� /1___.___- teri 1 <br /> `( <br /> No of.compartments.---- y size--- <br /> Disposal <br /> Ma � �• <br /> �/ - • Liquid depth----(_0----------------Capacity----�P45 ' <br /> Disposal Field: Distance from nearest well __ O- r <br /> 4 yEIlfBistance from foundation___-.2-4i-------Distance to nearest lot <br /> ( Number: Iter es_-- ---------t�------------ --Length of each line-----_-.- - - ------Width of trench----- rC `� <br /> Type of:filter material___/�-_ �r <br /> ` Depth of filter material------ - ------r- <br /> � ------ L-___ <br /> th <br /> -- ------- _. _Seep ge Pit: —DTistancems_o—nearest'well_. <br /> ,-Distance from foundation___-. <br /> Number of pits__.____'_'____-- �, � ���- Distance to nearest lot line -_a r- 00 <br /> ______Linin material ize: Diameter• - <br /> Cesspool: Distance from nearest well--------_--------Distance from foundation__- Lining material_--______-----_--__-_- <br /> ---- Size Diameter ' =}. <br /> 7: �� :. <br /> . ,.. D pth -Li urd <br /> T.. " == q__ 1 apathy--=- - -- �gai <br /> �"` - [ <br /> Privy: Distance from nearest well--__ --- '._Distance from nearest building.- <br /> 1-:v,. -------- <br /> y... ---- --- <br /> k ❑ stance"to nearesf lot Ime------ ;�---p-- ----�. _. - -. _ ----------------------- <br /> ­-Di ---- -------- --� <br /> --------y---- <br /> ------- --- <br /> Remodeling and/or repairing {describe}:_:__:__-_-----,- „ v <br /> -i $ 1 �. ______________------_____________ ___ <br /> _ <br /> ct�—q.-----------------------------------------r_______-___ <br /> _______________ _ _ • ________.___ <br /> ________________-____ -________________ _ <br /> u • ___________________________ <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, State laws, and.rules afid regulations of the San Joaquin Local Health District. <br /> (Signed)--=.... --=; :. <br /> MA6.�!_ <br /> By: �- ---------------------------------- ---------------------{Owner and/or Contractor) <br /> (Plot lan, showin size of lot; ---•--(Title)------ ----- <br /> P g. L 1 ocation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> ] 1 FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------- ----------------- --------------------------------------------I--------------------- DATE------/ <br /> REVIEWED BY ------------ <br /> ----- ---- ----- DATE <br /> BUILDING PERMIT ISSUED-__,--------------- " <br /> = ------------------------- DATE <br /> A terations and/or recommendations:-- _----------- - - -=-----------------___-____-____- <br /> -------- •-------- <br /> ------------------•--•---- ---------------- <br /> I ----------- -------- ----------...: <br /> ---------------- -- -------I--------d <br /> -- ---- I 1 <br /> - - - ------------------------ ---- <br /> ----- ------------------------•-- <br /> --- r <br /> ------------------ -------------------- ----------- <br /> ---------------•-------- ------------------------------------------------- - ' <br /> ----•-- <br /> ------ <br /> FINAL"INSPECTION" <br /> ----BY::.-- a -�- �- <br /> ....� <br /> -• Date--`- -=----- <br /> _.r ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street .300 West Oak Street <br /> 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California <br /> Manteca, California Tracy, <br /> rc � California <br /> ES-9-2M 1e7 � � 77v� A� [v - egj/71p <br />