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APPLICATION FOR SANITATION PERMIT Permit No. ___.72_��__7 <br /> {Complete in Duplicate) Date Issued ---:N/>0L <br /> Applical-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 Count Ordina ce o. 549. <br /> 00� <br /> JOB ADDRESS AND LOCATIRN-- --- - -- --------- -- ------ _ca.'—----------------_---- <br /> Owner's Name------------------- ----- - - - ---------- ....... ---- --------------------- ------------ -------- Phone------------------------------------ <br /> Address-------------------------------------3 _­ ------- - - --- -- --- ------------ -------------------------­--------------- -------------------------------------------------------- <br /> Contractor's Name---------- -------------------------------------------------- ----------------------------------- ----------- Phone------------------------------------ <br /> Installation will serve: Residence (Apartment House E] Commercial E] Trailer Court [:] Motel El Other [I <br /> Number of living units: I--- Number of bedrooms _/_ Number of aths .-4-- Lot size <br /> ---------------------------- <br /> Water Supply: Public system E] Community system El Priv ;;De'rfh to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand M rGravel 0 Sandy Loam�r Clay Loam E] Clay [-] Adobe t-] Hardpan E] <br /> Previous Application Made: Yes El No [200' New Construction: Yes V No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic k Distance from nearest well-5-20 Distance from �unclation/0----------------Material----12�dILOA-_04-------------- <br /> No. of compartments_____&_-."%AL........Size_5r'X--- y---Liquid depth------3................Capacity____ Q------- <br /> Disposal Field: Distance from nearest well-1A..........Distance from founclafion_!4.............Distance to nearest lot line---0 ......... <br /> Number of lines--------67'._.�_ _- .--- Length of each -.................Width of french-------PL ;0..................... <br /> Type of filter rnaferia6.-.g Depth of filter material------/__T71 1-------Total length------- ---- -------------------------- <br /> Seepage Pit: Distance to nearest wek----------------------Distance from foundation------------------_Distance to nearest lot line__.______________ <br /> ❑ <br /> ine----------------- <br /> El Number of pits----------------------Lining material----------------------Size: Diameter-----------------------Depth-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation- - -_ -----------Lining material____..___________._._________________- (A <br /> F1 Size: Diameter-_.------------ -------------------Depth---------- --- -------------- ----------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------- - --- ---------Distance from nearest building------------------------------------------ <br /> Distanceto nearest lot line ----------- ------------------------------------------------------------------------------------------------------------------------ <br /> Q <br /> ---------------------------- <br /> vj's <br /> ---------------------------­---------__--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- <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 Joaquin Local Health District. <br /> (Signed)- e-------- ---------- ---- ----------- ---------------- ------------- ---------------------------------------------------------(Owner and/or Contractor) <br /> cle—--- ----------- ------ <br /> By:----------------------------------•-------•-----------------------------------------------L---------------------------------------(Title)------------_------------------------------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to <br /> W�Ils, buildings, etc., can be placed on reverse side). <br /> FOR DEPART ENT U.S! NLYA <br /> APPLICATION ACCEPTED BY-../-</.f---7_ - ----- ---- - ... D AT E_ ---7. ------------------- <br /> REVIEWEDBY------------------ - -------------------------------------------------------------------------------------- ---------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------- ------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-•------------ - ---- ­ ­ ----------------------------------------------------------------------------I------------------ ----------------------------- <br /> ---------------------------------------------------- --------------------------------- ------- ------------------------------------------------------------------------------------------------------------------------ <br /> ----I--------- ------------------------------------------------ ------_ ­­­--------------------------------------------------•---• ------------------------------------------------------------------------------ <br /> ------------------------------------ ----------------------------------------------------------- ------------------------------------------------------------------------------------------------ ------- -------­-------- <br /> ------------------------------------------- ---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION 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, California <br />