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_ . _ 7_ �• <br /> APPLICATION FOR SANITATION PERMIT Permit No. ., .. , <br /> (Com lete in Duplicate) ! <br /> P Date Issued6 � <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descFibed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---------1_7/-7 4�7--------------- --- ---- -------­----------------­--------------------- ----- <br /> Owner's Name _----- --- ! -- : - ---- Phone........----_---------------_- <br /> Address <br /> -_ -----Address / s ------ - ------ ---------� ------------- <br /> Contractor's Contractor's Name--- - --- -- 'd -' _a.---- Phone-.-J-4- <br /> gap ----------- <br /> ---------- <br /> s <br /> Installation will server Residence Apartment House❑ Commercial ❑ Trailer Court:❑ Motel ❑; Other ❑ <br /> Number of living units:-__/_ Number of bedrooms _-9. Number of baths _ --_ Lot size .__.,4_&'"1•01---A-?_-0_-__-_- <br /> Water Supply: Public system ❑ Community system ❑ Private th to Water Table $'o ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ' Sand Loam Loam Clay Adobe Hard an <br /> P ❑ YY ❑ Y ❑ p ❑ <br /> Previous Application Made: Yes ❑ No New Construction;.. Yes 901<0 ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <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 /> No. of compartments---_---------------------Size---------------------------------Liquid depth Capacity <br /> Disposal Fiel Distance from near t w _{+._------Distance from foundation-_. -_'-_.___Distance to nearest lot line--- <br /> t <br /> Number of lines_- _0 __ Length of each line..... Q r, Width of trench <br /> .�..� Type of filter material4t -_-Depth of filter material__- .- ----Total length______________� •-_-__---------- ----- <br /> Seepage Pit. Distance to nearest well_-_--__Distance from foundation._.........Distance to nearest lot line.171 __.. <br /> Number of pits--- -------- ---Lining material-----------------------Size- Diameter-----_ ------------:Depth--------------------------------- <br /> Cesspool: <br /> ----- --------------_-- <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 /> ❑ Distance to nearest lot line-------------- ------ ------- ------------------ ------ -------- <br /> / `f <br /> Remodeling and/or repairin (describe): � L ---- -------- ---------- ----- <br /> -------------------------.................... --- - -•----------- -------- - -----------------------------------.............................................................. <br /> ------------- -------- --------------------------------------- --------- ------ -------- ----------------------------------------------_-------- <br /> I hereby certify that I have prepared this application.and fhafi the work will be done in accordance with San Joaquin "County <br /> ordinances,'State laws, an®rullesnd ulations of theS n Joaquin Local ealth District. <br /> (Signed) } - - -_ --- -------------ABy:------------- ---------------(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 /> APPLICATION ACCEPTED BY - '------ ---------------------- DATE- ---------------------------------------- <br /> VREVIEWED BY- .................. - . DATE_ <br /> BUILDING PERMIT ISSUED-----------------------------------------------------------—-------------------------------------- DATE- -- 6•' <br /> ' --------------------------------------------- <br /> Alterations and/or recommendations- ------- ---------------------- ----,.__. ----- ------------------------------------------- ------- -------- ... ------------- <br /> --------------------------- ----------------------------------- -------------------------------- <br /> ---- - --------------------------------------------------------- <br /> -------------------- •----- -------- <br /> FINAL INSPECTION BY: -------- -------- -------- 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-9-2M 8-51 Revised W-2100 <br />