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L <br /> --��- ° " - <br /> APPLICATION FOR SANITATION PERMIT Permit No...� <br /> b` = (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 herein described. <br /> This application is made in compliance with County Ordinance No. 549.[�, <br /> t C O� x-----' � -------------------•-------------------- <br /> A <br /> JOB ADDRESS AND LOCATION -l � � <br /> Owner's Nam•e_-'--_---L-- -- -1 rr ---------,_- ------------- ------------------------- ----- -- <br /> ------- ---- Phone-J0­01{'I <br /> = <br /> Address--------------------------------------- ---------------------•----- ------------------•---------- <br /> . _.. <br /> Phone <br /> ContractorsName--------------------- -• ------------- ----------------- -------------- --------•------ ---------- ----•- <br /> Installation will serve: Residence ®Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> _ �. <br /> Number of living units: -----_ Number of bedr, s _ ____ N mbar of baths _____ Lot sae ........' --------_? ________________--_-- -_--_ <br /> Water Supply: Public system P�Commun'ity system vate ❑ Depth to Water Table .------- ft. <br /> Character of soil to a depth of 3 feet: Sand ElGravel El Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [2!�IardQan ❑ <br /> Previous Application Made: Yes ❑ No ©,/ New Construction: Yes [' No'❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet) <br /> r,�,� .. <br /> Septic Tank: Distance from nearest well- __.__--___Distance from foundation__/a--- --.--_---.Material____ �t--- IlV_- -------- <br />'f ❑` No. of compartments- Size_ ---------Liquid depth----�-f---------------Capacity---- <br /> Disposal Field: Distance from nearest well-) --.Distance from foundation---!A_f........Distance to nearest lot line____ ___f_-_-__ <br /> ® Number of lines______ _________ Length of each line-------W----.-i----- Width of trench-` Y---_-----..----_--_----- <br /> Type of filter material.____, ?di--__--Depth of filter material--_-_ ----------Total length_______t_!1----------------------------- <br />'s Seepage Pit: Distance to nearest Well---------------------Distance from foundation------z_a___..____.Distance to nearest lot line____:._______--. <br /> 1 ❑ 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 /> from nearest building \\jPriv Distance from nearest well--------------------------------------------- --Distance ng----------------------------------------- <br /> Distance to nearest lot line----------------------------- ------------------- ------------------------ <br /> Y= <br /> ❑ --------------- --- -- ---•---------------------- <br /> Remodeling and'/or repairing (describe)----------------- --------------------------------------,--------------------•---------------------------------F------------------- \ <br /> j •------------------------------------------------------------------------------------------------------------- <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> 1 ' <br /> -a- <br /> �. _� Owner and/or Contractor) <br /> (Signed ---- _ <br /> IJ `-- -- -- - 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 /> ------------- DATE-----------y--=" ��-- - ---------------- <br /> APPLICATION ACCEPTED BY----- - ------ <br /> iREVIEWED BY--------------------------------------------------------- - DATE <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations:-- ---------- --------------------------------------------------------- -----------gp___ET-----A1��1-------V7__--- <br /> r L <br /> 13ff Nreb-----`-T� -------ny _12---------�------a w__ 1��----�1p-�-----I <br /> � _i R _. WA-FF ----=► + - -.._� � �Tl <br /> ------------------------------------ <br /> FINAL INSPECTI��-- ------ - ,.:� 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-4-2M Revisea 1-57 F-P.CO. <br />