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(' APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />gv <br />Permit No- _-............... <br />I ` i <br />Date Issued ---•- <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 Ordinance No. 549, <br />JOB ADDRESS AND LOCATION_.. �- <br />__ ,II -&N -. <br />-__.. -_--Y. _ .I <br />Owner's Name______________ --------------------- - -- <br />------------------- ...... --------- Phone------------ _--------------- <br />Address ----------------_------------ <br />------•---Address----------------_-••--------- --am—e - <br />Contractor's Name---- ---- ----- P.f-&I---------- ------------------------------------------------................ Phone..A---OY4.407.... <br />Installation will serve: Residence [B"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />Number of livingunits:._._. Number of bedrooms __ Number of baths ._ e Q_�_. ___. -/_ao - <br />1__. Lot size .___.. <br />Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablelikk. ` <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes ardpan ❑ <br />Previous Application Made: Yes ❑ No New Construction: Yes [] No [r' <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />l <br />Septic Talk: Distance from nearest wall ..... ..........Distance from found .. <br />ationj..A.........- Material __.._e--- ------------------- - <br />No. of compartments.... _.a� ------------Size___,�`�-!' ."_'Eiquid depth ...... if---- <br />----Capacity__.----�-----. <br />6 3 '' <br />Disposal Field: Distance from nearest well...Distance from foundation --- / 0_"~__. -.Distance to nearest lot line...,....._.._ <br />Number of lines .-_____-�______ Length of each line-_../,y�_`-------------Width of trench..___�.`f."._._--.--____. <br />ir <br />Type of filter material____.. __..3... Depth of filter material..-_...��,' !____.Total lengthI.'.__- <br />Seepage Pit: Distance to nearest well -t-10 -- -._-_Distance froey ndation----- -p.. �. Distance to nearest lot line--- --s ---�- <br />Number of pits .... .... .......... Linirg materia l_-__.__....___�-Size: Dia meter. -3.3-`' ...... . Depth.___Z4 �_ <br />------------ <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_--:.:.. r`-----_--------- - ------------------------ ------------ <br />Remodeling and/or repairing (describe): --------------------------------- ---•-------------------------------------------------------------------------------------------------------------------- <br />----------------------------------------------------------------------- -•-----•---•--•--••------------•-•--•-•-----------------------•-.....----------------------•------•-------._.._.....--------- <br />-----------------------------------------•---•------•.................................. ............... ...................................... --•------------------------- -..... ...... -•----•-•---•.---------- --------- <br />........................... ........•--•-----------------------•--•--•-•-------•-------•---- •-------•--•-----------------------------------...----------------•-------------------- ­ ­ <br />------------- ........ <br />I h ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinan1,15 tat laws, and rule and regulations of the SkJoaqu4n, Local Health District. <br />(Signed)-------�-------- . <br />---------------------------r�� <br />---------------...--•-- - - ContractBY• -- - ----(Title)or(Plot plan, showing size of lot, location of system in relatiobuildi s, etc., can be pla ed on reverse side). <br />FOR DEPARTMENT USE ONLY �1 <br />APPLICATION ACCEPTED BY -- DATE =.......... <br />REVIEWED BY---- ---- - ---------------------_ ------... •------DATEj ���•� — <br />----- DATE------ --- --•---.......------- -------------- <br />BUILDINGPERMIT ISSUED ---------- __------------------------------------------------ --------------------------------------- DATE ---------- ............ <br />Alter�attions and/or recommendations:_....__ ......._...-...__-.._ <br />2 A-� %� /( W� r—tel '.............``ti_._____t. ! ��_._.____-.__..__.__.-__.___--___ <br />r-- ---- G_.l ....... 1--------•--•- <br />---- --- ......... ... ........ •-- _ <br />r ............... <br />-------�� -� ----• --� � .rte--.�------ ----•- - ------ �.:� l���. � - . <br />---•..................................... ................ ... .......................•--•-----.--.........-------------------------------------.........---------------------------------------------------------------- <br />FINAL INSPECTION BY:... - /- �-------------------------------------- - Date.. .......... <br />.....- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street <br />Stockton, California Lodi, California <br />ES -9-2M . Revised W-2100 <br />132 Sycamore Street 814 North "C" Street <br />Manteca, California Tracy, California <br />