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APPLICATION FOR SANITATION PERMIT Permit No.70/ � <br /> `7 (Complete in Duplicate) Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereindescri ed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-_�_f.:`77A.....�`7_-----I--k. -------- `- --�----!�'���'-------------------- <br /> rr, f±�.r2��� V p <br /> Owner's Name----Com__,-- --_._--- ---- Phone----- __ _d-_ <br /> ---------------------------------------------------------------------------- <br /> Address-------•--••--------•-3...1`� l--- ------- <br /> Contractor's Name-----------6r ,� Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---1__ Number of bedrooms ..;-Z_. Number o baths .,... Lot size ....R-0Y.A-0-1­--­----------------------- <br /> Water Supply: Public system [I Community system ❑ Private Number <br /> to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Sand <br /> 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.._,S' johf,'Bistance from fourd„5tion._�Q- _.Mate�al----- _ _ ............ <br /> 5Q No. of compartments------"I----------------Size_---X_4j_X__-__._-:Liquid depth------,/.'.__._.______._Capacity_- ----_--�� <br /> Disposal Field: Distance from nearest well_SO/11op-Distance from foundation....A0-maZistance to nearest lot ling,s-).......... <br /> Number of lines...........--_._ ...__.__ ________ <br /> .Length of each line.._....!!6_ . _ Width of trench...... .._._ <br /> �* ,r------------- <br /> Type of filter material.___ ,__ _ _Depth of filter material____ .__._ _Total length..__.._.,/.."Z-�.._____..___...__ <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-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> El <br /> -..__- ____-__--____---_.-____-❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity--------------- gals.. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------._.--_-____-..___-__.__.___-._-. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------•---------- -• ------------------------------ <br /> Remodelingand/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, Sta laws, and rules and regulations of the San Joaquin Local Health District. <br /> E <br /> . <br /> �� f <br /> (Signed)--•-- -----f�lJ----- t --------------- ----------------------------- ----------------------------------------(Owner and/or Contractor) <br /> By:-------------------------------------------------------------- --------------------------------------------------------------------(Title)----------------------------------------------------- <br /> ---------- <br /> (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). <br /> ORD§EARTMENT USE ONLY oe <br /> APPLICATION ACCEPTED BY--------------- --------------...................................... DATE--------e�Xe ----------------- <br /> REVIEWEDBY---------------------------------- ------------------------------------------------------------------------------------------- DATE-------------------------------------------- <br /> BUILDING PERMIT ISSUED------------- ---------- ------ ----- -- ---- ATE.. <br /> tt - J <br /> Alterat'ons a or ec mendations:._�1 '1.Ma � A., .� <br /> A <br /> ----- - -------••• -- -- --- <br /> , , <br /> -------------------------- ---------------------------------------------------------------•------ ---------- --------------------------------------­ ------------------------------------------------ <br /> % ,. <br /> FINAL INSPECTION BY:----------------/ ..---------------� ------�---- ..�. Date----------- --------------------------------- ----------------------------- <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 10-52 Revised W-2100 <br />