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APPLICATION FOR SANITATION PERMIT Permit No. ------ ____ <br /> - - <br /> / (Complete in Duplicate) Date Issued �____ _6_ __— <br /> Applica¢ion is hereby made to the San Joaquin Local Health District for a permit to construct and inst I the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. Ie7l— LO�t)-0--3 } <br /> 0-a -- <br /> JOB ADDRESS AND LOCATION..../WN JQ1PO,��-.------- ---- -----------OU, ,.-----------4_ / <br /> Owner's Name---------- -------- L{�C/� -----�---g-------------------------------- - -------------------------------------- - Phone------------------------------------ <br /> Address x `� ' �� ------- Cl� <br /> Contractor's Name ---------- Phone./_!.�--! <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court !W/ Motel [3 Other [I i <br /> Number of living units: -------- Number of bedrooms ________ Number of baths -------- Lot size ..... <br /> �4_-- '------ .------•---------•----------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table J-�—ft. <br /> Character of soil to a depth of 3 feet: :Sand E] Gravel El Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ ; <br /> Previous Application Made: Yes ❑ No PL New Construction: Yes ❑ No [� ✓ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1 <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 /> ❑ �S �� No. of compartments--------------------------Size------------------------•-------Liquid depth---------------- ---------Capacity----------------------- <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_______-________ <br /> ❑e-xrslC Number of lines-------•---------------------------Length of each line-----------------------------.Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material------------------�----Total length-------.-------------------•-------e__­ <br /> Seepage <br /> _ -Seepage Pit: Distance to nearest well_ _ . . _ .. Distance from foundation__-jP4_______Distance to nearest lot line___�4�- ____{ <br /> 11 <br /> Number of pits.- --------Lining material_ 2J-Gl-C---Size: Diameter _ _________Deptn____ .__. --------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation..--.--------------Lining material------------------------------------- <br /> Size: <br /> --________--______.__--_________ -_Size: Diameter---------------------------- ---------Depth-- ------------------------------- -----------------Liquid Capacity----------------------------gals .. <br /> ❑ Distance from nearest building -I " <br /> Privy: Distance from nearest well --------------------------------------- - g <br /> El Distance to nearest 4ot line. = ---------------- <br /> Remodeling and/or repairing (describe)____________ ___ ,_._[-------------__ __ <br /> --- <br /> - -------------------------------------- <br /> ------------------------------------------------------------ <br /> ---------------- <br /> - ----------------------------------- ---------------------------------------------------------•------------...------------------------- ------------------------------------------------------------------------------------ <br /> 1 hereby certify that-I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State ) ws, nd rules and regulations of the San Joaquin Local Health District. <br /> `` / �/�6 <br /> (Signed)---_ fJ ! F� ------------?Ilation <br /> - --- ------------•----- -------------------------------------------------- {Owner,and/or Contractor) <br /> By: �1 <br /> .�- = ------ --(r+le) --- -------- <br /> (Plot plan, showing size of lot, location of system in r to wells, buildings, etc., can be plat d on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------------------------------- ---- -- ---------------------- ---------- DATE------- -- ----------- <br /> 'REVIEWED BY-------------------------------------- ---------------------------- DATE 7-� --------------- ----------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------•- ----------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:------ ------------------------- -------••----------•-------•------••---•------------•- -----•---------------------------------- <br /> -------------------------•--------------------------------------•--------- ---------------- -------------------- ----------------- <br /> ------------------ ---- ------------- --------------------•- --------------------------------•--- / sF <br /> s' --- <br /> �, Date--------------- 7 <br /> FINAL INSPECTION BY---- --------------------- - -��-v��---------- 1--�- ---- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 4 Stockton, California Lodi, California Manteca, California ,Tracy, California <br /> ES-9-2M Revised W-2100 <br />