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FOR OF <br /> Permit No. <br /> ._r �___ _4 __; _ APPLICATION FOR SANITATION PERMIT <br /> ---------- - ----------------------------------------- (Complete in Duplicate) Date issued _- �/ <br /> -------------- This Permit Expires 1 Year from Date Issued <br /> ------------- <br /> Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County OrdinanceNo.No. 549. <br /> JOB ADDRESS AND LOCATION ZC1__-- /"'✓------•--•---------•--------------------•-----------------------------•---•--------------------------•----------- <br /> Owner's Name-------.!/_x&11 ----- ----• Phone...................... <br /> Address------.. -----------I-------------------- ......-----------------------------------------------------------------------•-•------------------- <br /> Contractor's Name------------- - - ...------...---'�� --------.------------------------------------------------------------------ -•---- Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___1!___ Number of bedrooms .--ZNumber of baths ---I--- Lot size -----4,117 b-•----------------------- <br /> Water Supply: Public system 911-,Community system ❑ Private ❑ Depth to Water Table 4 -- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 3 <br /> Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes El'-No ❑ FHA/VA: Yes ❑ No ®-' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r <br /> Septic Tank: Distance from nearest wellz�__Distance from foundation__&_-------.-Material------------------------------------------------- <br /> No. of compartments------Z---------------Size----- '� C .:.__Liquid depth------!�--- ---------------Capacity--- � { <br /> Disposal Field: Distance from nearest welL_ `-�-Distance from foundation.LQ__.�_____ .._._Distance to nearest lot line__�'��_______ Q <br /> / �y <br /> Number of I'sees-----------•�-------------LL- Length of each line-------5' __.__- Width of trench..-----2�'-f------------- -- <br /> Type of filter material.._.T!__C_1>=___- -Depth of filter material____It_y__-_______Total length___.....___�-�-•-­----------------- <br /> - <br /> ----------------- \ <br /> Seepage Pit: Distance to nearest we41___� S-_--Distancerfr�om� foundation__�a_______------Dista ee to nearest lot line_____._.__ <br /> _____Lining material_____ltG_C�-�;�...Size: Diameter_-__._,�0-_ p <br /> ❑� Number of pits------�------- Depth <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-___-._---.___--_-____--__._____.... <br /> ❑ Size: Diameter------------------------------------- Depth---------------------------------------------------Liquid Capacity-----------------------__gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line---------------------------------------------------------------------- ----- --•------------------ •-------------------------------•------ ,V <br /> Remodeling and/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 an a lations of the San Joaquin Local Health District. <br /> (Signed) (Owner and/or Contractor) <br /> 9 ) --- ------ <br /> ` = ---•------------------------ ------------------(Ti+le)------------------------------ -------------------------------- <br /> By:(Plo+ 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 /> APPLICATIONACCEPTED BY------ -------------------------•--•------------------------------------ DATE----. ---------------------------------- <br /> REVIEWED BY------------------------------------------------------------------------------- <br /> --------------------•----------------------- DATE---------------------------•------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------- ----------------------------------•----------- ------------------- DATE---------------- ------------------------------------------- <br /> Alterations and/or recommendations:__s = �O ........ --- ! SII `------L-...<_..__..____.1---1.0 --- <br /> FINAL INSPECTION BY:-----e = -------------- - -•---- Date-- - f' --------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 FEVIBED D•59 F.P.CD,2M 6.90 <br />