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APPLICATION FOR SANITATION PERMIT Permit No. ..'��' p..!Lr�. <br /> (Complete in Duplicate) 6 <br /> 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-------- .� 4R-------- -----•-------Cif--��` 1-- ' d C,./>✓_, '�(�l <br /> h /�� <br /> Owner's Name.........................................� ...f_"�EA.e_.--_ -------------------------------- Phone------....=........--- <br /> Address--------------------------------------------------------------------.............�-ti......--------------•--------------------------------------- ...------------.5 76.L <br /> Contractor's Name.................................................... ------------------------------------------------------------- Phone--------•------------- ' �..... � <br /> Installation will serve: Residence par <br /> Atment House E] Commercial E] Trailer Court ❑ Mote Other E] ^ <br /> Number of living units: __._ _. Number of bedrooms ._�--- Number of baths -------- Lot size ___________ ________________________ <br /> Water Supply: Public system Community system E] Private ❑ Depth to Water Table ------__ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [[ New Construction: Yes ❑ No E <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-----------------Distance from foundation.-_-__-________---_.Distance to nearest lot line................. <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of 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-----------------------,_._.-____ <br /> Cesspool: Distance from nearest well--_`� __O-_-_Distance from oundation. ,/D---------Lining material--- <br /> Size: Diameter-------- --$---------------Depth-------- r�- ----- ---------- ---=-- --Liquid Capacity.-//�_P 4;?............ <br /> Privy- Distance from nearest well- ------- - ---- Distance from nearest buildingV ----- <br /> Distance to nearest lot line- -•- -----------------7_'}_l ................. <br /> Remodeling and/or repairing (describe):__-*......A)./2„-______�<.?qlG--.--__-_� ..______._ _ l_.4-_y/+....____./�_ _ <br /> -----------•---•--------------------------------------------------------------•-------------------------.---------------------------------------------------------------------- / IJ <br /> ----------------------------------------------------------------- <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) +� <br /> ---------- <br /> ---------­------------ - ---------- --- --------- -------- -- ------(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---- <br /> REVIEWED BY----------- - . ( <br /> b 6 _ <br /> DATE .................... <br /> BUILDING PERMIT ISSUED------------------------------ - --------------------------------....................................... DATE------------------------------------- --------- <br /> Alterations and/or recommendations:._ <br /> __ <br /> L -- ................ ---------- --- <br /> -------------- --- <br /> ----- ------- -- -- - ------. ---- - ---I <br /> > � � <br /> --------------------------------------------------------- <br /> w <br /> FINAL INSPECTION BY---------------------------_-- ----------------------------- Date---------------------- �1---- <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 Revised W-2100 <br />