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APPLICATION FOR SANITATION PERMIT Permit No. ___-_ <br /> (Complete in Duplicate) <br /> ... bate Issued ------- ----- - <br /> ' t <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. 1/ <br /> JOB ADDRESS AND LO ATION-----C24 ..�--------------- `�-� �1 --e' --------�-.lt 'i.-�L- <br /> Owner's Name-------1 - --------- ------------ -- - ------------------------ Phone----------------------•---------•--- <br /> Address------•124o..s------ --- ---........ ,tea------------ - <br />' Contractor's Name------- ----- ------- --------- --- ------------------------•-----------•----•- Phone---•--------•-----•--------------•- t <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> 'Number of living units: _/---- Number of bedrooms ___VrNumber of baths ---/.- Lot size -----l_.._ - __ __ - _____________________ <br /> Water Supply: Public system B—Community system ❑ Private ❑ Depth to Water Table,(,_L3_ ft. <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 Construction:~Yes ❑ Nod�_ Y <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well----A/07 dDistance from foundation__.>2a_-.____.Material----5. ._ ---_-_---------------- <br /> No. <br /> --._-_-.--------_____.No. of compartments-_____ ------------- ....Liquid .______..Capacit y_.._ L?__.___ <br /> Disposal Field: Distance from nearest well_./..(��_41'stance from foundation__.,07..__.Distance to nearest lotRL <br /> Number of lines_________ _______ -Length of each line___, Width of trench___ ----_________.____ <br /> Type or filter material----li-.__.SX__Depth of filter material_._-,/__Y-.--------Total length----- o_______---------__ <br /> Seepage Pit: Distance to nearest well__440'P..l�_Dista ram oundatto _ _-a_------Distance to nearest lot line-____-. _ <br /> Number of its-------._ . _Lining mat ial_e +ie: D ameter._ .��.-_-Depth_._ .____..._ <br /> i <br /> Cesspool: Distance from nearest well-------------_---Dis __.._.Lining material__._______..__.____.-______-____.__._. <br /> ❑ .Depth--------- ----_----Liquid Capacity. ------------------- ,---gals. <br /> Size: Diameter------ - ------------ - ----- ------------ ------------------ <br /> Privy: Distance from nearest well----__-------------------------------------------Distance from nearest building------------------------------------------ <br /> D <br /> � <br /> ❑ Distance to nearest lot line--------------r-------------- ---------------------------------•------------------------------------------------------------------------------ <br /> Remodelingand/or repairing (describe)-------------------- ----- -----------------------------.-------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------- •------------------------------------•-----------------•-------------- -------------------------••---------------------------- ------ <br /> ---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- <br /> I her4cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, and rules and regulations of the San Joaquin Local Health District. <br /> -------- {Owner and/or Contractor <br /> BY� {Title) i <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ----- ---- DATE <br /> REVIEWEDBY----------------------------------------------- --------- - ------- ----------------------------------------------- DATE------------------ ..� ------•--------------- ------- <br /> BUILDINGPERMIT ISSUED------------------------------------------- ----- ------------- ---------------------------------- DATE.-------------------- - <br /> Alterations and/or recommendations;-------_-------------------------- <br /> � 5 ' <br /> ----- <br /> ----- <br /> -- ------ ---- --------------_- ---------------•----------------•-----•------------_-_----•---•-- <br /> -------------•- <br /> yJ --- ---------------------------------• •----------------------- -------------------- --..._.. <br /> ----------------------- =�---------------------•----------------------------- <br /> ------------------•----------------------------------------- ------------------------------=-------------------------- <br /> - ------------------------ --.------------------------------- -•--------------------------------------------- <br /> i <br /> FINALINSPECTION BY:------- ------------------------•---------------- 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 /> —2M 145ggb A7Wn0o 1254 <br />