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APPLICATION FOR SANITATION PERMIT Permit No. <br /> Duplicate)D <br /> i <br /> t <br /> CZs ` <br /> (Complete n up <br /> . `'Date Vssued <br /> A '1lcation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> PP <br /> pP compliance with County Ordinance No549., <br /> This <br /> application is made �n com t � <br /> /� --------- - <br /> -- <br /> JOB ADDRESS AND OCATION_�__(,/___-- -_-. <br />` /' Phone_ ------ <br /> Owner's <br /> `� :�----- <br /> I <br /> Owner s Name l / � --- -----a <br /> Address r� ------- <br /> Phone <br /> ?`.rr <br /> Contractor's Name__. -------------------------------------------------- <br /> Ph one--------•--------------------------- <br /> --------------------------------------------- <br /> Installation will serve: Residence �A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i <br /> tt <br /> Number of living units: __- __ Number of bedrooms _- _ Number of baths ---!____ Lot size _ ______________________4f----------------_- ----- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Sandy Loam " Clay Loam Clay ❑ Adobe/Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y © Y ❑ <br /> Previous Application Made: Yes ❑ No �/ New Construction: Yes WNo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: (& <br /> (No septic tank or cesspool permitted ' public sewer is available within 200 feet.) p r <br /> Septic Tank: Distance from nearest welV <br /> Distance from,fou tion_-_-1-�-------Mat r'aL--__- ____ --- - --_- . <br /> Capacity-.-- <br /> of compartments - ze�-_ --- -------Liquid depth------ --------- ----- <br /> No. i <br /> Dispos Field: Distance from nearest wel _'�f ,Distance from foundatio �__- E--__Distance to nearest lot line_i�-_____-----_. V <br /> Number of lines--..______..<>�--��t--------Length of each line._ _�__� - Width of trench-._.___�/__!i'____�------------- <br /> Type of filter material -1 A D.epfh of filter material__--_-f- _ --____.__Total length-------------1 <br /> Seepage Pit: Distance to nearest well--------------------- 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 /> ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid CapacitY---------------------------gals. <br /> Privy: Distance from nearest well--.-"--___-_-- ..-.----__---------------------Distance from nearest building------------------------------------------ <br /> 0 <br /> -_.---.--___--- ..--__---.__-------__--.❑ Distance to nearest lot Vine------------------------- - -----••------------------------• ----•-------------------------------- <br /> Remodelingand/or repairing (describe):-•-------------------------------------------------------------------------•-------------...-------------------..-_.---------------------------------- <br /> -------------------------- <br /> -------------------------------------------------------­----------------------------------------------------------------------------------------•-•-----•-----------------------..._...-------•--------- <br /> 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 Sao/0�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 /> REVIEWEDBY----------------------------------- r -------------------------------------•-------------'=---=`----------------- DATE I( - ----------------------- <br /> BUILDING PERMIT ISSUED------- -- - --- - -- -- ----------------------- - --------- DATE----------------�� ' <br /> ------ <br /> Alterations and/or recomme dations:-.-.-----.-___--- ---------- ------------------------- <br /> ; _. -- j p ------------------------- ----------- ----------------------------- --------------- ---------•------------- <br /> { !- �' :4/'a f' _J r Y S`" fS_---..__-_ ?---------- -------------- <br /> --------------------------- <br /> 0— M <br /> ------ r• ------_-------_'----_---_----__----_-_-_----_-----------_--- <br /> ' <br /> lam— J`A $�Py' ?`�, �.�. <br /> FINAOINSF E�TION BY:_ Date--------- <br /> AN JOAQUIN LOCAL HEALTH DISTRIC /[J <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street r14N.rfh "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br /> f� <br />