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APPLICATION FOR SANITATION PERMIT Permit Wo. _._!3__S___��------ <br /> (Complete in Duplicate] l' <br /> L^ Date Issued <br /> Applies{ion is hereby made to the Son Joaquin Local Health Qistrict 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..___ a......Z?A `­-- - <br /> Owner's Name--- <br /> Address <br /> ame ---------- ------ --- ------- Phone------------------------------------ <br /> Address------ --- ----------------- ----------------••---------- --•--------•-------•----•-••--------------------------------------------------- <br /> Contractor's Name-..- 'i�L ...-- fJ+-G Phone <br /> Installation will serve: Residence ®'i partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: ,q <br /> 1.-_.. Number of bedrooms _�_ Number of baths _�.._ Lot-size _�+!-------X___�_a'�____a_._...___..____ <br /> Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table _�Krft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No 2�' 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 Ta Distance from nearest well/ �4�'�bistancel!from foundation_ _________.Materidr___ .-- .._,_.___"___. <br /> pC� Liquid d�pih__. Capacity- <br /> -- <br /> No, of com artmenis_., Size- .-_.----_-._ <br /> r <br /> Disposal ield: Distance from nearest well.*?__ Distance from foundation_ _._______.Distanca to nearest lot I�e---, <br /> Number of lines-------- __.- - ...__ Length of each line__-_4-_.Q_______________Width of trench.-__ ---._-.____._--- <br /> Type of filter material-/,,.-._ _ _ . Depth of filter material----I ..._.. ..Total length------y�AV------------------------- <br /> Seepage Pit: Distance to nearest well_- - `bistance fro fsoun ation___-___ . -------- n e to nearest lot line__1 __..._ <br /> Number of pits:-----�-------------Lining material-e&1 ize: Diameter_-� ..._-.----Depth------ _7--------------- <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-------- ------------------------------------------------------------------------•---•------ - --------------- <br /> r <br /> Remode€ing 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, ano rules and regulations of th San Joaquin Lac Health District. <br /> 60 <br /> (Signed) „ -- ----- -- ------------ - -- --- - -------- =---••------------------{tea Contractor) <br /> Y= ---- --- - -- ----------------------------------------------------(Title]- t�rj -� ° <br /> (Plot plan, showing size o , location of system in relation to wells, buildings, etc., can be placed on reverse e]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - DATE_ . <br /> REVIEWEDBY---------------------------- -- ----------- ----------------------------------------------------------------------------- DATE_ --------------------•---------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------ ------------------------- DATE----.�^ --------------------------------------•-- <br /> Alterationsand/or recommendations:---------------------------------------------------------------------------------------------------------------------------------•----------------------------- <br /> ------------------------------------- t <br /> ----------------------------•- ---`ri-- 8----- ------ -----------------------------------------------------------_"-_.------------------•-------------------- <br /> -------------------------------- ----------------------------------- ------ --------------------•----- "-------- ----------------------------------------"------------------------- ---------------- <br /> FINAL INSPECTION BY------------------ -5------------------------------------- Date.... . ----------------"-------------------- <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 /> ES-9 145446 Arwood <br /> h- <br />