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V u -(o APPLICATION FOR SANITATION PERMIT Permit No. ._.7 -5._ <br /> s S- - <br /> (Complete in Duplicate( <br /> Date Issued <br /> l <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..l549. <br /> JOB ADDRESS AND LOCATION_: QS...2.---- ..................................... <br /> Owner's Name - f!>r�i Q_! '!►, C�'1 .Q Phone <br /> * <br /> Address---------------------------------- <br /> Contractor's <br /> -------- -•-------------•--•-Contractor's Name.......................... [?!!Rd... ................................................. -------- ................... Phone................................... <br /> Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: )..... Number of bedrooms --- Number of baths ........ Lot size ............................................ <br /> Water Supply: Public system Community system ❑ 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 ❑ <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 /> El <br /> ________ __________--__-_--__--..-_--_-___--.E No. of compartments------------ ---:...-Size------------_--- - ---•-----Liquid depth-------------------------Capacity----------_-----_--- <br /> Disposal <br /> -- ---------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 french----------------------------------- <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 /> El Number of pi+s--------------------- Lining material---__ _- --Size. D.iaam1eter- --_. -__-----Depth -.----- -_...-- --•----••--- 4 <br /> Cesspool: Distance from nearest well__,6r677---Distance from foundation_--/w___:---- Lining material._ ,' ---- N <br /> 0 <br /> Size: Diameter--__-.7.-_X_ -7------------------Depth_.__ ... ---------------------------- Liquid Capacity _ t„ <br /> - q P Y------------ ------------gals. <br /> Privy: Distance from nearest well ____ _ _________________ __--..-Distance from nearest building._-__--_-.__.--._------_---.:._-_---_--_. <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe)-------- -----•--- ------•-------------- --------- -.__..--- ----•---- --------•-------•--- -----------------•-•---•---•-------•------•- <br /> .. --•--•. •--••-----••---•-------•------•. •-•-•-. ------- ------------------------------------------------------------------- <br /> I hereby certify that I have preparedthis application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules andre ulations of the San Joaquin Local Health District. <br /> .(Signed) '=--•----- -----------­------------------------- ----------(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 /> APPLICATIONACCEPTED BY------------_------- ------------------------ ------------------------ ---- -------- DATE.................................................. <br /> REVIEWED BY-------- . ----------------- ----•.... DATE---- --- <br /> BUILDING PERMIT ISSUED_:..___ _ _____________ ____ _ 1t <br /> ------------- --•---------------- --------- DATE----------- --------- ---- <br /> - -------------------------------- <br /> Alterations and/or recommendations:............................................. ............................................. <br /> - -- ------------------------------•--•--...------------------...--------•---•---------•----•--•---------•-•-------------...---•---------•--------........................................... <br /> .......................... ------------------ -•-•- -------x-----a--------- - ---- --------------------------------- ---- ---- ••------ -- <br /> FINAL INSPECTION BY: -----IS-------- - ---------- Date-------------------- <br /> SAN <br /> -.'`"? -------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Stree+•. 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOO 12-54 <br />