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! . <br /> APPLICATION FOR SANITATION PERMIT Permit No. .-1Q:?../. . .. <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 /> JOBADDRESS AND LOCATION.......... -----------------13----------------------te----------------------------...•-----------••---=---•-•-•-----------•----------•------•----••--- <br /> Owner's Name............................................. ----­------- ) ------------------_ ----------------------_-- --------------- Phone------------------------------------ <br /> Address-------------------------------------------------------------------------------- ,( -------•---------•---------------------------------------------•----...----•-......---•-•---•....•..... <br /> Contractor's Name--------------------------------------------------------------- `f---------------------------------------------------------------... Phone----------------------------------- <br /> Installation will serve: Residence] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms .-'2— Number of baths -------- Lot size ....__.____. �_.__ -- s�.__-...___________.•- <br /> Water Supply: Public system j�d Community system ❑ Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay [:] Adobep Hardpan ❑ <br /> Previous Application Made: Yes ❑ No O, 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.) f <br /> Septic Tank: Distance from nearest well-_41Y..... <br /> Distance from foundation...__. ______-..Material--------------l.� _C, <br /> �( 9X---moi-----X3.Liquid depth--------4V --------Capacity----- •S"v <br /> J� No. of compartments___.____,-___.._ _.__Size..____ <br /> Disposal Field: Distance from nearest well �G_.__Distance from foundation._ .__ ...__.Distance to nearest lot line----------------- <br /> Number <br /> ...__.--...Number of lines---------------3.11-.1----------Length of each line_b------I------------------- of trench........1✓Lf��-__--_---__ <br /> __ <br /> Type of filter material------1J�-__-----_--_Depth of filter material------Jb -------_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--------------------------------- w <br /> Cesspool: Distance. from nearest well-----------------Distance from foundation-----_-----------__.Lining material-------------------------------------- <br /> 0 <br /> ___-..----___ _--:.___,___- ._<.-.❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building.-___--__---..______•_....---_-_-.-.-___-. �N <br /> ❑ Distance to nearest lot line-------- ---------------------•---•------------•------•--------•--------....--..--•------•-----•----•------------------------------- <br /> Remodelingand/or repairing (describe):----------------- -----------------------------------------------------------•------------------ ........................................................ <br /> ------------------------------------------------- ...........................•................................... <br /> l <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. V <br /> (Signed) . ...... ------ ---- ------------------------------------------------•_-----------------------------------(Owner and/or Contractor) <br /> By: . -•-• (Title)--------------------------------------------------------------- <br /> (Plot plan, showing size of lot, locat of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------------------ ----------- DATE-------------- �-�ea 'fJyC----------------- <br /> REVIEWEDBY-_---------------------- ------------------------------------------------------ ------------- --------- DATE. <br /> BUILDINGPERMIT ISSUED...................................................................................................... DATE. <br /> Alterations and/or recommendations------------------------------------i------- ----- -------------------------------•----...--------------------------•----------•-.......••--•-................... <br /> f,•-4-0----4� u----------&...------4w"4-----------------------------------------------•----•--.......------...------------ <br /> ----------------------•---- - -------------.-...--------------------------------- <br /> ••---- <br /> --- <br /> t------� - ----------------------------- ---- ------ <br /> FINAL INSPECTION BY:--- . ... Date.---- n�'.. -':...�. .--- <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 145446 ATWDDD 12-54 - <br />