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A <br /> APPLICATION FOR SANITATION PERMIT Permit No. :.../.,�. ..... <br /> (Complete in Duplicate) <br /> Date Issued ___...__//1,� <br /> Applica-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des6ibed. s <br /> his application is made in compliance with County Ordinance No. 549. <br /> JOB <br /> CATION ------ -- ----------------------------- -------------------------------------------------------- <br /> /� � �v - �" , <br /> Owner's ADDRESS e.A 1?' �...- ... -- <br /> ---------------- <br /> ----•. Phone.......... ----•---- <br /> Contractor's Name._--- � <br /> - ----------------�------------------------ --------------------------------------------------------------- Phone._{S._ 1 <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑, Mojel ❑ Oth - ❑ <br /> Number of living units: --t---- umber of bedrooms ._. Number of baths ----t.- Lot <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4--' <br /> ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes 9,-No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest well-------------- Distance from foundation....................Material ___...._.____--__ ___ _____.__ ..._........ <br /> ' No. of compartments--- ----------- -----Size--------------------------------Liquid depth--------------------------Capacity----------............ <br /> Qisposal ie d: Distance from nearest well-.---------------Distance from foundation_-----------------Distance to nearest lot line-__--_ ---.----- <br /> Number of lines-----------------------------------Length of each line___-_.---. . ._---_---_. Widtl4ttif trench <br /> Seepage! Type of filter material----- - --- ----- ---Depth of filter material-. -.-_-. __.---------Total length-------------- <br /> Pit: Distance to nearest well__711'.-! ---Distance from foundation'.�► fl- ...Distance to nearest lot line..._._ <br /> Number of pits.---1_._____----_:__Lining material...i� 4---------Size: Diameter.....liq-__ _ --------�� <br /> --._--_Depth_ _-_. __f..___.___ o, <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-- -------------------­ <br /> N+. <br /> O ❑ Size: Diameter------------------ -------_---------Depth---- ----------- ------ • --- ----- ----Liquid Capacity-------_-------------- 9als.l <br /> rivy: Distance from nearest well....---------------------------------------------Distance from nearest building____-__________________ <br /> ❑ Distance to nearest lot line------ <br /> Remodeling and/or repair ng (describe):---- 1./ Y= ---•-- ------ ------ --.-_- �----------------•-. <br /> ca --------I----------- - -------------------- ----------------I� --- --------- -- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- ---------------------------------------•---•-•------•---••--•-•-----•----•----•----•---......-----•--•---.-------------------------•-----•----------••=...._...._....... ----_..._----. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinan- aws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ;�_ --------------- and/or Contractor) <br /> BY< �! -� �`.----------------- --------- ------------------- ETiti0)-----�Owner. <br /> (Plot plan, showing siz of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse si� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- ------ ------ --- -- •--------------- DATE <br /> REVIEWED BY •-----••--- DATE---------------- <br /> -------------- ----- <br /> BUILDING PERMIT ISSUED------------------------ ------- -- -- ------ -----------•-------------------------------------- DATE----- -• - <br /> Alterefions and/or recommendations:. . <br /> 1W-------•--- <br /> i '�� -- <br /> -- <br /> - -- -- ----- --- -•------..._•--• --•------ •-------- ................ <br /> FINAL INSPECTION BY:. Date......... fl.' ! 5 <br /> SAN JOAQUI OCAL 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 /> E5-9 145446 ATWDOD <br />