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.1 7�1 • <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application 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 /> JOB ADDRESS AND LOCATION--------------------Flia/,----------- ----------------------- <br /> Owner's Name-------------------------------- -•----I �l ------ r''l;'-/-h7_ : 1"r �� Phone --------------------------- <br /> Address------------------- � �--------•-------- ----------------------------------------------------------------------------------------- <br /> Contractor's <br /> •--------------s-------------Contractor's Name--------------•----------------------------------------------'=-- ---'--- ----------------------------....---•------------------ <br /> ---------- Phone_ 6-- <br /> Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ------- Number of bedrooms ------!l- Number of baths ----- Lot size _-_------_____ y_'.____________.__________ <br /> Water Supply: Public system ❑ Community system ❑ Private k1 Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe f] Hardpan ❑ <br /> Previous Application Made: Yes ❑ Nom New Construction: Ye46 No ❑ <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-________________Distance from foundation--------------------Material------.--------------------------------.._------. <br /> ❑' No. of compartments------ -------------------Size--------------------------------Liquid depth----------- --------------Capacity------------------- <br /> Disposal Field: Distance from nearest well......�Z-----Distance from foundation-___- O-'�-_-__.Distance to nearest lot line____--------_-� <br /> Number of lines----------------/-----------------Length of each line-------------1 ___....Width of trench---------.- --+r---__---------- <br /> f Type of filter material--------/_1�_S''k�a.__Depth of filter material------J�------------Total length_-_--_-.�r.�l----------------------�Q <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 /> EJ <br /> .---_-_--------_._-----_.-_____ _-❑ Size: Diameter--- ------------------------- -------Depth----------------------------------------------------Liquid Capacity----------------- ---------gals. 1 <br /> - i <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------_-------_-------------------_. <br /> ❑ Distance to nearest lot line--------- ---------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe) --------------------------------------------------•-------------------------._•----.._-•----- -------------------•----------••----....__--_--------- <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)------&-----k.... f ---- - ------------------------ ---------------------------------------------(Owner and/or Contractor) <br /> By:--------------------------------------------------------- -------------------------------------------------------------------------(Title)---------------- --------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------------------------- -------------------------------------- DATE--------- 2 <br /> REVIEWED BY----------------------------------------------•--------------------------- ---------------------- <br /> ------------------_ - DATE------------------------�7__-------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ ----------------------------------------------------- <br /> Alterationsand/or recommendations=-- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> -- ------------------------------------ --- --• - ---- ---------- ---- + <br /> i�` - -r ._.t ---� '-- "---- - -- ------ <br /> ----------------------------------------------------------------- <br /> M_.._...-- _�_.__. r ----------------- <br /> FINAL INSPECTION 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 /> ES-9-2M 10-52 Revised W-2100 <br />