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APPLICATION FOR SANITATION PERMIT Permit No. J3_.b Y <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct n instal the wor herei d,eiscribe <br /> This application is made in compliance-with Count Ordinance No. 549. , �, <br /> +� <br /> JOB ADDRESS A LOCA IONtf_-- 1 _ --- --- -- ------ --- ,. a <br /> A Owner's Nam 1 ------------- ...1._ � Phone_ _hl-- <br /> Address........T-� -- ---- ..! <br /> !` <br /> -------------•----------------•------------------- <br /> Contractor's Name--- -------------------------- ----••---------------------------------------------------------------------•--------------...._. Phone---•-- •----------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Mot0 Of he[ ❑ <br /> Number cf living units: ___ __ umber of bedrooms Z Number of baths -1----- Lot size _ _:�-l/____________________------ <br /> Water Supply: Public system M Community system-❑- private ❑ `Depth'to Water Table--------- <br /> __.___ ft_ - -" — <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel ❑ Sandy Lo;'No <br /> Clay Loam ❑ Clay E] Adobe 2 /HardpanE]Previous Application Made: Yes E] No IR/ New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted.if ,ublic sew r is available within 240 fee .) I S <br /> Septic ank: Distance from nearest wel r�A�stancp fro ffoun tion'l_A ---- at�ri I <br /> No. of compartments----_---___14+ iz _+ _ ` ----Liquid dlepfh --- - -------------Capacity----_ Q ----- , <br /> �yy I <br /> Dispos I�Field: Distance fio_m nearest 1 11 ! istance from foundation_I- _____ isfance to nearest I t 11 e fes __.____ <br /> [V Number of lines___._____ �.L ength of each tp__(9--14t-.Width of trench-__. _ ___�`!_� <br /> T_. 0-1---------------- <br /> Number <br /> of filter mater ,,rDepth of filter material___.___._ <br /> �- Total length--------- _/�__--------------------- C <br /> Seepage Pit:.. Distance to nearest well____...____---_.A_TDistence 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 <br /> m�ate-rial---------------- <br /> 0 <br /> __-____.___ <br /> ❑ Size: Diameter--- Depth _ = a__l_s_..: <br /> C-- ------------- apacity- ----------------- <br /> ' <br /> Privy: Distance from nearest welld Distance from nearest building__ ______.__ <br /> ❑_.. ' Qistance to nearest lot line----------- ='--------------•---------------- •----------------------•- --------------- --------------- ----------------------- <br /> i <br /> Ramo a ing and/ repairi (describ r- --------- -----------ti---------------------------------------•--------------- <br /> /'yvij �_ - -------------------------------------------------------------------------------------- --------------------- <br /> ---- --------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------- <br /> ------------------------------- -----------------------------------•-----------------------------------------------------•-• ----------------------------------------•------------------------------------------ <br /> I hereby certify that I have prepared this al plicafion and that the work-will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the SanJoaquinLocal Health District. <br /> (Signed)--------- eZ,, C. <br /> •--------- --------------------------I------------------------------------------.-(Owner and/or Contractor) <br /> By:.- ------------------- --------------------`------------------------(Title)------------------------------------------- - ------------------ <br /> (Plot plan, showing size-of lot, location of sys1em in relation to wells, buildings, etc., can be placed on reverse side). <br /> .FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE�---------- ---------------------------------------- <br /> ----- -------------------------------------------------------------------------- <br /> REVIEWED BY------------------------ 1 = DATE__. <br /> BUILDINGPERMIT ISSUED ----------------------------------------------------------•--- -•---------------------- DATE-.------- ---------------------- <br /> Alterations and/or recommendations:------------___--------- _ _ <br /> -- <br /> --------------•-------------------------------------•------ i - - ------------- -------- <br /> d <br /> --------------------------------------------------- <br /> FINAL INSPECTION BY:... ------------------------------------ Date------C /. /.--- <br /> s Y <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 />