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APPLICATION FOR SANITATION PERMIT �� Permit No. <br /> (Complete in Duplicate) !D <br /> Date Issued <br /> 070,13 <br /> Applica}ion is hereby made to the San Joaquin Local Health District for a permit to cons ruct and O tail the work herein describ <br /> This application is made in compliance with County Ordinance No. 549. ,� ��, �., d7 a�ej <br /> JOB ADDRESS A V <br /> LOC T10N_ �. -�- --' - sem.-�1 �_��_a______�5 <br /> Owner's Name--------- -- ------ -- ---- - - -+,1�� '^ Phone 7�--'�.SZ� ----- <br /> - <br /> -------------•---Y--- --10-----�-�-- �---�-,------ - --- <br /> Address { n 47-------------------------------•-•-•-- ------••---•----------•----- <br /> Contractor's Name----------� ref—C1�-�� =�€�!� �.h�-� Phon <br /> Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ ___ Number of bedrooms _, -_ Number of baths --/-- Lot size ---------____________ <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -------- ft. <br /> Cha atter of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam lay Loam [D Clay L] Adobe❑ Hardpan E]Previous Application Made: Yes L] No New Construction: Yes W/IGo ❑ <br /> TYPE` OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> / f <br /> Septic Ta k: Distance from nearest well _-------Distance from faundation_E_ - _-_..__ Mater*al__ r -. ___.____ <br /> No. of compartments-------- -----Size6 .....................-- = q p -- l/ p, Y-•-- <br /> �! � �_ Liquid de th__:�_ --___Ca acct �'����_ <br /> Disposal Field: Distance from nearest well__,5�._�,_Distance from foundation--------. Distance to nearest lot lin <br /> e.,�.�' <br /> Number of lines________ --------- Length of each line? f 5'!,_;2X_. Width of trench.- . __.____._____-____ ' <br /> Type of filter material---t----___-------------Depth of filter materiall'?.._`_____-_Total length____/•SM_'__________________-_ <br /> 0 <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 /> 0 Size: Diameter._ ----------------------------------Depth-------.--------------------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well -._.-.-__.---------.-------------------------------Distance from nearest building_'__________-________________--_-.-__-._. <br /> ❑ Distance to nearest lot line- ----- ---------- ------ ----------------------------------•--•- ------------------------------ <br /> Remo ing a d/or re airing (describe]: _____ __ -----L_1_11. �- .�__ -. <br /> --------dui. . + <br /> F I <br /> ------------------ --- --- <br /> i <br /> here y c rtify at I-havejp <br /> ared this application and that the work will'be done in accordance with San Joaquin County <br /> ordinances,. a laws, an rulesregulations of he San Joaqui ,Local Health District. <br /> (Signed)----- -- ----- ---------- ------- `-- -------------------- ---------- ------- --- - - ---- ---------------------------------- ,, _ r 14ontractorj w <br /> BY= .._.. ----- ---- (Title) �c -l�'1� CII <br /> --(Plot plan, showing size of lot, location of system i elation to wells; buil gs, etc., can be placed on reverse side). �¢ <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ----- - --- -- - -==----------------------------- DATE------------- - - .-' <br /> REVIEWED BY------------------------------------------ <br /> �+'L' 1- G �---- <br /> - ---- - - - ------------------------------------ DATE----------------• -•---- --- •-------•------------------- <br /> BUILDINGPERMIT ISSUED----------------------------- - ------- --•------- -----------------•--------------- DATE-- ------------------------------------------------------- <br /> Alterations and/or recommendations----------- ------------------------ ----------------------------- ------------------------------------------•----.--------------•---------•- ---­- ----- <br /> -------------------------------•------------ --------------------------- -------------------------------------------------'---------------------------------------------------------------------------------------------- <br /> --------------- ----------------------------------------------------------------------------------------- ---------------------------------------------------------------•-•----------------------------•-------------- <br /> ---•----•------•- ------------------------------------------------------------ ------------------------------------------ --- ---- ----- ------------------------------------------------------ <br /> FINAL INSPECTION BY:----- -- -----------------------------•---------------- Date. ! ----- --�------------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT l�il <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lode, California Manteca, California Tracy, California <br /> ES-9- 2m 1x5446 ATWODO 12-54 <br />