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APPLICATION FOR SANITATION PERMIT Permit No. ____G__ _ <br /> (Complete in Duplicate) <br /> Data Issued ._____1_l.�,/_? <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 /> vANQ LOCATION --- . ----- <br /> JOB ADDRESS - ------ ------------=---------------- <br /> - Phone-------- <br /> ---------------------------- <br /> Owner's Name.--. - ---- <br /> 7 <br /> Contractor's Name._-.Y� �r ��Cd�Z1 -- c'----- --------����� ----------­­ .. -•- ---------------- Phone-101/0-- <br /> {9 d <br /> Installation will serve: ,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ! Number of living units: - ____ Number of bedrooms _. _ Number of baths - Lot size ______%'<$. X__J_ - ____________________ <br /> Water' Supply: -Public system Comjmunity system ❑ Private ❑ Depth to Water Table`S____ t. <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 Con`ruction: Yes ❑ No 0, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i ....- <br /> (No septic tank'or-cesspool permitted if public sewer is available within 200 feet.) <br /> . - - _ <br /> .�- :.r-�.� ,R.m -- <br /> Septic Tank /„ ,� ps rom nearest wel!_______________ Distance from foundation-------------------_Materiai__________________-_________-_________________. <br /> ❑. J/G�_'.'i`lo. of ompartments---------------------------size---------------------------------Liquid depth--------------------------Capacity..------------------f- <br /> Disposal Field:. ..Distance from nearest well----------- Distance from foundation____....C3._t___.Distance to nearest lot line__��0___.. <br /> Number,of lines_________/.-__- -. 'Len th of each line__________ Width of trench- ..__ _ <br /> Type of'filter material___/,,3----- Depth of filter material-____/.�_ __=_`Total length_______ ....................... �- <br /> Seepage Pit: Distance to nearest well__: � ► •:Qistance from f undo ion____ __. rst nc�`to nearest lot line_____ <br /> Number.of its.__.___ _ --Linin material_&__�- -Diameter_'__ --------.Depth------- ----------- �1 <br /> p ---_-- 9 I, <br /> Cesspool: Distance from nearest well_______________�Distance from foundation--------------------Lining <br /> ! <br /> material__.______________._________________- <br /> Size: Diameter________ _______4_-------------------De th------------------------------------------------ -Li Liquid Capacity_---------------- - •-----gals. <br /> tEl I <br /> Privy: Distance from nearest well ___------------------------------------------------._Distance from nearest building__,----------- __-__-__.._-._-_--_______. <br /> ❑ Distance to nearest,lot.line'_'___..__.______ _.__ "." " - <br /> Remodeling and/or repairing (describe).--L.- <br /> --- ------------ ---------------------------------------------------------- ------------------------------------...------------------------- <br /> ---••------------------••--------------------------- ----- --- ------------------------------------------- --------- ---------•--..-..-•------- ----- ------------------ ------------------------------- ------ <br /> - ff t . . . : I <br /> --------------------------------1-11 -------.-.--. ------.-•-----------------------------------.------..----.-.----•--------------.•-------.------------------------------------------------ <br /> } � i <br /> I hereby pf'tfy <br /> I have-prepared this application and that the work will,be done in accordance with San Joaquin County <br /> District'- <br /> ordinances. Std rules and regulations of the'San Joaquin Local Health District:-(Signed)----------- , -f- ------------------(Ow and/or Contractor) <br /> itl <br /> (Plotplan, showing size of lot, location of.system in relation'to wells, buildings, etc., can be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY . <br /> APPLICATIONACCEPTED BY-----------• }--------- --------- -------------- ------------------------------------------------ DAT --- - ------------- <br /> REVIEWED BY i =------- - 5 - DATE <br /> �.. <br /> BUILDING PERMIT ISSUED------------------------------ ----- - DATE--------..-- ------ <br /> ------------------------------------ <br /> ---------------- <br /> TE <br /> ----- <br /> ---- ---------------------------- <br /> Aiterations and/or.recommendations: --�- ---------.-•-------------•--•- ••--•-----------------•- •. •... -- ` <br /> i ...... ......... <br /> ----------------------------- -------------------------------- - -- <br /> z -- --- --------- - <br /> ------------------------ _ <br /> # <br /> --- � -=_- -• 'FINAL INSPECTION Date.-- � ' <br /> S <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 /> E5-9---2M Revised W-2100 <br />