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APPLICATION FOR SANITATION PERMIT Permit No. __:��Ll��r------ - <br /> (Complete in Duplicate Date Issued __ __ _ -�`--- <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 /> JOB ADDRESS AND LOCATION___--- 2 <br /> -------------- 4---------------- ---------- ------- <br /> -----/ <br /> Phone------------------------------------ <br /> I/Y <br /> Owners Name. 7/ _ <br /> r --------------------------- <br /> ------------- ----------------------------------- <br /> Address-.... <br /> ----- one <br /> ------------------------------------------- <br /> Contractor's Name-------- __ <br /> Installation will serve: Residence Er-Apartment House ❑ Commercial ❑ Trailer° Court ❑ Motel ❑ Other [3 <br /> Number of living units: J-___ Number of bedrooms __`;_7.I*lumber of baths 1/--- Lot size ___�_�--lJ---✓ -� `3-----•----~•---- <br /> Wateir Supply: Public:system FgL Community system ❑ Private ❑ Depth to Water Table _dft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam [I Clay Loam [I ' Clay Adobe❑ Hardpan E] <br /> revious Application Made: Yes ❑ No E§._ New Construction: Yes No ❑ . <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} <br /> ----------------Distance from foundation----_----••-----•--.Material_____-.___.------------------•----- <br /> Septic Ta stance from nearest wellf compartments---- ---- -------- - Size-___ - Liquid depth Capacity <br /> Disposal Field: Distance from nearest well_..-_.___._____Distance from foundation_______________----Distance to nearest lot line._______________ <br /> ❑ of lines-----------------------------------Length of each line.-------- ------,::...........Width of trench----------------------------------- <br /> 0 ------------ ----------- ----••-- <br /> Ty of filter material-------------------------DEpth of fil I----------------------7otal length------------------------------------------ <br /> Ty <br /> _Distance to nearest lot line- ------ <br /> y .� ,. <br /> Seepage Pit= Distance to nearest ell_- �Distan from faun4eJation Depth <br /> e: iameter__ <br /> Number of pits________ _____________Lining mafier L_�r ��'� Q <br /> Cesspool: Distance from nearest well_________________Dis ante from foundatio --: _.Liquid Capacity-.______________-_______gals. <br /> i ❑ Size: Diameter----- ---- - ---- Dep <br /> Distance from nearest well----------------------------- <br /> ------Distance from nearest building.----------------------------------------- <br /> Privy: . . ;. .. -------------- ---------- <br /> Distance <br /> -- - <br /> Distance to nearest lot line--------- -------------------------------------------- <br /> I Remodeling and/or repairing (describe)-------------;-------------- - <br /> e; -----------:. <br /> ( --------- <br /> - - ------•------------------------------••-------•----=----------------------------------------------- <br /> I hereby ate if wshaanI hrulespaedared this <br /> ns application <br /> the San Joaquin that <br /> the <br /> work <br /> Heawill <br /> lth District.in accordance with San Joaquin County <br /> ordinances, St <br /> ner and/or Contractor) <br /> or <br /> (Signed} ------- -- ------------ <br /> ----------------------------- <br /> i (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 /> DATE----------`I--------------------------------------------- <br /> APPLICATION ACCEPTED BY---- ----------------------- ---------------- DATE - -----••--------------------- <br /> REVIEWED BY----------------------------------- <br /> DATE <br /> = - <br /> BUILDING PERMIT ISSUED------------------------------ <br /> ----------- --------..- --------- <br /> Alteretions and/or recommen a ions:_____.; <br /> ---- <br /> -----=------- <br /> ------------------•--•-------- --••• ----- <br /> .,, <br /> ------------- ----•-------•-- - ,/-- f ---------------------•--------•-------•----- ------ .---- -------- <br /> ------ - ---------------------------------------------------------------------- <br /> -------------------- <br /> ------------------------- <br /> -------­------ <br /> ---------- --•----+. J <br /> ...... <br /> J <br /> FINAL INSPECTION BY:_°_ _.___ -- - ----- <br /> ---•---• Date----------------r--------- ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street` 814 North "C" Street <br /> 130 South American Street 300 West Oek Street Y Trac California <br /> Stockton, California <br /> Lodi, California Manteca, California Y. <br /> ES-9 145446 nrw000 <br />