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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Apation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work^herein` scribed. <br /> This application is made in compliance wit Count rdinance No. 549A, <br /> j. <br /> JOB ADDRESS ATfo <br /> ....--- --- ----------- ----------------------- -- -- ---- ---- ----------------------------------------------------------------- ---- ------------- <br /> Owner's Name - ---------- ------------- -- Phone.-Z-------f .. = <br /> Address------- . ---- ----- . - -- --------------------------------------- <br /> Contractor's Name---------------------------- - - --------------------•---------------------------------------------------------- Phone................................... <br /> Installation will serve: Residence (yApartment House ❑ Commercial ❑ Trailer Court ❑ Mot l ❑ Othej <br /> ntel <br /> Number of living units: -Xmmunity <br /> mber of bedrooms . _ Number of baths J... Lot size --f.� V- _I_�_ _.lf_- <br /> Water Supply: Public system system ❑ Private ❑ Depth to-Water.Table ------ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam Clay Loam Clay [j Adobe 8---`Hardpan E]Previous Application Made: Yes F-1No2"' New Construction: Yes [f�No ❑❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if�j ublic wer is available within 200 feet.) <br /> S@pti Tank: Distance from nearest welft_'� ___`Distance from foundation--------------------Material-----------------------.------------------------- <br /> No. of compartments-- x p,�p Size--------------------------------Liquid depth--------------- - ----Capacity--------------►------ <br /> Dispos i d: Distance from nearest w IIGy"1""'�istance from foundation__ ) .. Distance to nearest lot line_ <br /> r..------... <br /> Number of lines___________ _____ 1-____.. Length of each line____.._________ Width of trench_____.___.__ _ <br /> 8 _ <br /> Type of filter maters .�epth of,filter material ------_Total length-•--•----------7_c�r--•----------•- <br /> w <br /> Seepage Pit: Distance to nearest well----_-------------_---Distance from foundation....................Distance to nearest lot line---------------- <br /> Number <br /> --___-- -.-_-_Number of pits-----------------------Lining material..._-.f................Size: Diameter------._...------------Depth---------- ------_,.----_--.- <br /> Cesspool: Distance from nearest well-_---_-_-_-_-_.-Distance from foundation--------------------Lining mateFial----------------------------------- <br /> ❑ Size: Diameter----;,------------------------------Depth----------•----------------------------------------Liquid Capacity----•----------•------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_-_---._.-__.__--_-_-_-__-_--_--_.-__.-. <br /> ❑ Distance to nearest lot line----- ----------------------------------------------------------- ------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe) i----------------------------------------- ----------•----------------•--------------------------- <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 /> ordinances, ?faja jlla , and ru s an r u sof the San Joaquin Local Health District. <br /> - -- <br /> (Signed) f (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 /> ._a <br /> REVIEWEDBY-------------------------------- ---- --------------------------------------- --------------------------------------------- DATE------ -- - <br /> BUILDINGPERMIT ISSUED----------------------- ----------------------------------------------------------------------------- DATE----------Q[%.------............... ---------------------- <br /> Alterations and/or recommendations--------------------------- -------------- --------------------------------------------------------------------0------------------------................... <br /> ---------------------------------------------------------------------------------------=----------------------------------------------------------------------------------------------------------------------•--------------. <br /> ------------I-------------------------------------------------­----------------------------------------------------------------------------­­---------------------------------------------------------------------------- <br /> ---I--------------------------------------------------------------------------------------------------------------------------------------------• ---------------------------------------------- ------ ----------------- <br /> --------------------------------------------------------- <br /> -.----...-•------------------------------ --- ---- - ---- -- ------------- <br /> FINAL INSPECTION BY:. --------------------------- Date ----- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT C <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 I0-52 Revised W-2100 <br />