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APPLICATION FOR .SANITATION PERMIT Permit No. __k?�__�'��.__-._ <br /> r�1�1 <br /> (Complete in Duplicate) r <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 Countc <br /> Ordinance No. 549. •�ytyjtil rvd���1Ttt •1.�� <br /> JOB ADDRESS AND LOCATION_. .-i � ----0. <br /> -- ..... ----------- - _p. . , - ; <br /> Owner's Name__. ���! -------- r1� 7.. �`- 4=------- e <br /> 4 <br /> Address >l ~�---- :: - Phone A <br /> - - <br /> Ile <br /> --------------------------------- <br /> Contractor's Name---- <br /> Installation will serve: Residence 2 Apartment House ❑ Commercial Trailer Court <br /> ❑ Motel E] Other ❑ <br /> Number of living units: _/_____ Number of bedrooms ___. __ Number of baths __ -___. Lot size _____. <br /> Water Supply: Public system E] Community system ❑ ' Private 2� Depth to Water Table Z->_ 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 ® New Construction: Yes R� No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 11 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ti <br /> Septic Tank: Distance'from nearest well___ ---_ E_O __Distance from foundation_..__LtMafer- <br /> i �e_e <br /> No. of compartments_ - s ` --------------------- <br /> ------------- <br /> - - -r-_ <br /> _._-__Size-_5--- Liquid de .th_ ---------Capacity --f._ � <br /> �.,. <br /> Disposal Field: Distance' from nearest well_-ZI _._._Distance from foundation_____1.�Lf- -.Distance <br /> nearest lot line__.,J-A `- <br /> Number of lines----------- Length of each Ir e_______ tS-_--r ----Width of trench-__.` -�`�_____________ <br /> - ----- <br /> Type of filter material_/_r�.___:�_R±_-Depth of filter mafieriaL ....1l----.----Total length---------- <br /> -------------------- <br /> Seepage Pit: Distance.to nearest well----- ____Distance from foundation------1Ljq____.Distance`to nearest lot line__._/�? _ <br /> Number of pits----------- Linin material__�'._r' Sqz do <br /> x-line- <br /> _/ <br /> g Diameter -�------Depth.=�'��` -----------•-----•.-. (D <br /> Cesspool: Disfance�from nearest well------------------Distance from foundation_____,--------------Lining material-___._____---__-.-___.___-,_ <br /> IO <br /> 1 ; <br /> Size: Diameter Depth ----------------'----------------------------Liquid Capacity------------------- -- gals, of <br /> Privy: Distance from nearest well---------------- <br /> --------------------:----- Distance from nearest building_ ---------------------------------- <br /> ❑ Distance to nearest lot line ! <br /> -----••------------------------------------------------------------- ----- <br /> Remodeling and/or repairing (describe)-----------------------------•----------------- -'-_..._ <br /> --•-----•------••-----•--------•---------•------------------•-- <br /> _____________________________________---_____-______-_________._.._____-__--__________-_.._______ R % <br /> _ _______________________•__________.________-_________•_-.-_________ i <br /> . ----------------_-------------------------------.------------------------------.._________________--___________--_________».________---___-___..-_______-__--__-._____-.__-________.__.____.._.________________-__._. <br /> ---------__________________________________________________________________________________________________________ ______ _____________________________________________________________________________ ___________ <br /> ! hereby cert' +ha+ I have prepared this application and that the__wor_k__will be done in accordance with Sart Joaquin County <br /> ordinances, State , and rules and regulations of the San Joaquin Local Health District. <br /> / ' , <br /> (Signed) iE �� - -?------- -� � .. ----(Owner and/or Contrac o <br /> By: � '-�._• -— �'� =Q J �. . .; Title __ <br /> ----.. <br /> (Piot plan. s owing 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 1 <br /> REVIEWED BY----------------- ------ -------------------------- J <br /> DATE r--- <br /> --- ------------------------ <br /> BUILDING PERMIT ISSUED f -------------- DATE..__.-._---------- =if - <br /> ---------------------•- <br /> Alterations and/or recommendations:-------------------------------------------------- <br /> --------------------------- <br /> ----._.--------------- <br /> ------------ •-----------•----•----- <br /> ✓4 _�T <br /> {{ <br /> Gt <br /> --•-------••-----•----------•-•------•----- I <br /> ----------- -------------------------------------------------------•----------`-----•-------••----------•------------------ <br /> ------­---------------------- <br /> --------- <br /> ----------------------------------------------- <br /> FINAL <br /> ' <br /> F1 <br /> INSPECTION BY:._ �----------------------------p----- Date---=-� �':---------�- -• -..3� ---------- <br /> -------------------------- <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 ntw000 12-s4 <br />