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} <br /> --�-^ APPLICATION FOR SANITATION PERMIT Permit No. <br /> alk <br /> t - <br /> ' �r v'�/ (Complete in Duplicate) / p J <br />€ �42/1 1Date 'Issued - -------------- •- <br /> Application 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 <br /> County Ordinance No. 549. <br /> JOB ADDRESS AND LOC TI cam--------�--- ----- ,f <br /> E Owner's Name-----•----- (�� Phone <br /> F <br /> EAddress--------------------••-•--- --------------•-------------------------------------------- ------------------------------------------------- <br /> Contractor's Name--------------- ----- ------ -•--- -•- ----------------------------------------------------------------------------------------------- Phone------------------------------------ <br /> Installation <br /> -------------------------------Installation will serve: Residencepar+ment House ❑ Commercial ❑ Trailer Court ❑ Mate.!/❑ ElOther K` <br /> Number of living units: _j__ Numb of bedrooms�y� Number of baths _1---- Lot size ___ r� __� ----------------------- <br /> Water Supply: Public system ommunity system '❑ Private ❑ Depth to Water Table .------- ft. ; <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe Hardpan E] <br /> Previous Application Made: Yes ❑ No Zj_--Nd Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' <br /> t SeRficTank: i�istance from nearest wel / Distance from foundation___ _______.Material__ _._ `______No. of com artments_ __ Size_____ 1r p ------------------- ---- - -X�Liquid depth- -----� - ------Capacity_.. <br /> Di s osal Field: Distance from nearest we1107z Distance from foundation---L_ ____ _.Distance to nearest lot linej ______ <br /> Number of lines-------- -------------------- Length of each line______ y -Width of trench__________ <br /> Type of filter material____ __ ._ _Depth of filter material----�- ...........Total length___________1__�______________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation----.------.--------Distance to nearest lot line----------------- <br /> "'4 <br /> El 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 /> F Privy: Distance from nearest wel{---------- ------_-------------------------------Distance from nearest building------------------------------_----------- <br /> ❑ Distance to nearest lot line---------------------------- --------------------- ---------------------------------------------------------------- ------ ----------------- <br /> Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------•------------•----•------------------------- -----------------------------------------------------------------------------------I------------------------- - <br /> I hereby certify that I have prepared this application and that fhe 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. <br /> x <br /> s (Signed <br /> ----------------------- ------- ??'" {Owner and/or Contractor) <br />' <br /> By:------------------------------------------------------------------------------------------------------------------------------------(Title)-------------------------------=------------------------------- <br /> r <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 /> APPLICATION ACCEPTED BY------------------­- <br /> ---------- - ----Y------------------- -------------------------------_-DATE-------/-��--ICk---•-, �____l------- <br /> ---- <br /> iREVIEWED BY--------------------------------- ----------- ------------------------------------------------------------------------------ DATE-----------------•----------------------------------------- <br /> BUILDING PERMIT ISSUED------------- ------- ---- -------- -- <br /> -- --- DAT ---------- ---- ------------------------------------------ <br /> Alterations and/or recommendations:___ �—� ate►. <br /> ----- --- <br /> -----•------------------------ <br /> -----=---------------------------------------------------- y <br /> ---•--------------------------------------- -- ------ -- ----= _ ----• ------- --- --- ------- --------- <br /> b ----- <br /> FINAL INSPECTION BY: Date -- ------------------------------------- <br /> r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> l 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 8-51 Revised W-2100 <br /> 1 <br />