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• <br /> APPLICATION ` 611 SANITATION PERMIT Permit No. -------------------- <br /> (Complete <br /> _ :--_3---..- <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applicallon 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 /> - <br /> .0.1 10 <br /> -JOB ADDRESS AND LOCATIO ____ . _ ` j <br /> �- �-- d � .-.--- -------------------------------------- <br /> Owner's Name a"fi�l..? Phone -li- <br /> --- ---------------------- - <br /> Address----- -------- - -------------- ------------------- <br /> - - --------------------------------------------------------------------------------------------- <br /> Contractor's Name------- ------ - - - ------- -------------------------------------=--------------- ---•------•-••---- ---- --•--- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑; Commercial ❑ Trailer Court ❑ Motel ❑ ..Other ❑ i <br /> Number of living units: .______ Number of bedrooms . -. Number of baths __ _.--. Lot sizeZ------------------------- <br /> Water Supply: "Public,system Community system ❑ Private ❑ Depth to.Water Table ___"__ ft. <br /> Character of soil to a ilep+h of 3 feet: Sand ❑ Gravel ❑ Sandy.Loam ❑ ,Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No�< New Construction: Yes4,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 Lance from foundation__.�-8_._-_'_-Material 4C:.1_ It <br /> __.__. F <br /> kA <br /> No, of compartments_- ,-----------....Sixe:... ►5'� --Liquid depth__.-- -----_:__-- P y <br /> Ca acit - - -. �� <br /> Dispos I Field: Distance from nearest well _ __ Distance from 'foundation----b_4..........Distance to nearest plot line_____--------- <br /> Number <br /> __ _____Number of lines------- ._.-. -_-_ Length of each line----4-6 __._____--_.Width of trench___ __ _____________ ` <br /> Type of filter materia ___ filter materiaL._. __�_ Total length------- _ }_(�______________________ <br /> Seepage Pit: Distance to nearest well__--------------------Distance from,foundation-------------..--.-..Distance to nearest lot line_--_.-_-_________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------------.-.Depth----------------------_---------- l <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-.-._..__-.-___-__..Lining material-------------------------------------- <br /> L1s Size: Diameter----- ------------ ------------------Depth_-------------- --- ---:--Liquid Capacity---------------------------gals. <br /> Privy: . Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line--- ---------------------- -------------- ----------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------- -------------­- - <br /> ------------------------------ ------------------•----------•--------------------------------------------------------------•---•-------•-------•---------------------------------------------------------------------- - <br /> I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, nd rules and regulations of the San Joaquin Local Health District. <br /> 5i nedOwner and/or Contractor <br /> _ <br /> (Signed) ----- ---- ---- ------- ----- <br /> BY•---------------------------------•----- -------------------------- --- ----- (Title) 4. <br /> • ._....__. Title .� <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 3 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_______________________________ ____ DATE_____1 _ <br /> REVIEWED BY DATE.-- --------!!t <br /> PERMITISSUED-------------------------------- ------- -•--------------------------------------------- DATE---------- J <br /> Alterations and/or recommendations:----------__>_...____. � <br /> FINAL INSPECTION BY:----- --------------- - ----------------- <br /> -. Date------f- ------------------ ---- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Straet <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> Er-3 145446 ATW000 <br />