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APPLICATION FOR SANITATION PERMIT Permit No. .... <br /> (Complete in Duplicate) Date Issued __._ <br /> Applica;ion is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herei dryr escribed. <br /> This application is made in compli with C unty Ordinance No. 549. /��J ,y� f <br /> JOB ADDRESS AND LOCATION- -• -- ---- = •. _.0'-g _. . <br /> / f t S'�� <br /> Owner's Name_uS1LC '� -�` -- S<ural.. -- --------- J-__ ' -c.`"`'f./.w) Phone r .. <br /> Y'h-.°.-�,t. - ------------------- - -- ---- - <br /> Contractor s Name------ •-----_--•.- <br /> -�`-- Phone .7 Q <br /> Installation will serve- Residence Apartment House ❑ Commercial Trailer Court 0 Motel ❑ Other d' <br /> Number of living units. _1__._ Number of bedrooms .-/__ Number of baths __ __ Lot size ____ .-T---- "--•-------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private R`__Depth to Water Table -------- 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 Ei3�o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or�sspcol permitted if public sewer is available within 200 feet.] <br /> Septic Tan :� Distance from..nearest-weli_�+� Distance from//foundation___' , <br /> No. of compartments.--- ------------ --Size_ t__ �� --i2c"--•---Liquid depth_-f-`- .�.-4� - ----Capacity.----- -- ----- <br /> T� --- } <br /> ��77 ,,��l!�rs eZAl r I <br /> Disposal Field: Distance from nearest well_v_._.__Dis7n from" tdGndation---- Distance to nearest lot liinv �.....- <br /> �� Number of lines___1____ �` Length of each line___.�7'__-�'-.-- .Width of trenchs� I <br /> Type of filter materia �.I�1�_._._Depth of filter matena ----- total length___ ---------------------- <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-----------•---------------gas. <br /> Privy:❑ •Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line.-.--- -- --- -----------•----------•-------- -------------------- ----------- <br /> Remodeling and/or repairing (describe)-------- -------------- -------- ------------------:•---------------------•-------------- <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 /> ordinances, State laws, and rules and regulations of the San Joaqui ocai Health District. <br /> DAY& i1°siGHT ---- Contractor) <br /> (Signed)------APRA _ - --------- - <br /> jary <br /> Car <br /> 12ti6 S®. Eldorado ti0 -�[t�.4� <br /> SY= it <br /> e)-- ------ ------ <br /> -----•------------Biro-IslFan�"�'ii sf^ <br /> (Plot plan, showing size of,lot, Iocar#ion of sy�Vem in relation to IIs, buildings, a ., can be placed on reverse side]. <br /> - FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------- - -- ----- --------------------------------------------------------- DATE------------ - - - � --- -- <br /> ----------- <br /> REVIEWED BY--------------------------------------------- ------- --- ----- ------ ------- <br /> DATE------ --- ---~--��---•--�----------------- <br /> BUILDINGPERMIT ISSUED------- ------ - -------------------------------•---- DATE----------------------------------------------------------- <br /> Alterations and/or recommendations:----------------- -------------------------------------------------------•-------------------------------------------------------- <br /> ... <br /> ------------------------ /_------- ------- ----------------------------- ------------------------------------•----- ---------------------------- -------•-- <br /> Date....__._.. - -_._. <br /> FINAL INSPECTION BY: = --- ; - - �,. <br /> 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> - 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street '"`; Y <br /> Stockton, California— ' Lodi, California Manteca, California Tracy, California <br /> • E5-9 <br /> 145446 GTWOO❑ Y - <br />