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L APPLICATION FOR SANITATION PERMIT P4*mit N* 2� <br /> (complete in Duplicate) <br /> S' " 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 Ordinanc No. 5 4. <br /> JOBADDRESS D L CATI N- ----- -_ ----- ---- - ----- ---- - - ------------­----------­--­-.............................................................. <br /> _ <br /> Owners Name-------- ------ -- •----- !•- -------- - <br /> --------------------- -- ------------- ----------- - - <br /> - Phone-- <br /> �---. <br /> • - <br /> Address------------ <br /> - ----- ------ ------- --------- -------- ------------------- -------------------- --•----------------- ---•------- ----------------------------- <br /> Contractor's Name----- -------- --- -------- .............................----------------- ------...................................... Phone---------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .___.-__ "mber of bedrooms _____-_- Number of baths -------- Lot size---------------------------------------------------_......_ <br /> Water Supply: Public system Community 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 ❑ <br /> Previous Application Made: Yes ❑ No Q� New Construction: Yes d No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee.) <br /> eir-Tank: Distance from nearest well-_----__-_ --Distance from foundation___________________Material. ....___...._____....._ .-_...... ------ <br /> No. of compartments---- --. ----Size------------------- --------Liquid dep h---- - ---------------Capacity ----------j•�. <br /> Disposid: Distance from nearest well_ Distance from foundatiori- Distance to nearest to Ir _ _....... <br /> [ Number of Eines.. ..:... .. ........... .Leith of each line........� .....Width of trench___-•-__ �-_-_---_.-____--, <br /> Type of filter materi ___- pth of filter material--.___�.. ____..-.Total length.......... -------------------- <br /> Seepage Pit: Distance to nearest well- --------- -----Distance from foundation-------------------- to nearest lot line................. <br /> ❑ Number of pits___ _______________Lining material-----------------------Size: Diameter........................Depth-__------_ -_----__.--__--__-- <br /> Cesspool• Distance from nearest well----------------•Distance from foundation____-____-___-__--•.Lining material__---------------- _-___--_- -_---:❑ 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):-------------------------------------------------------------------------------------------------------------- <br /> ............._............ <br /> j_--i <br /> I hereby certify that I have prepared this application and that the work will be one in.accordance with San Joaquin County <br /> ordinances, State laws, and rules�m%l,regula ' ns of the San Joaquin Local Health District. <br /> (Signed)- If ---- -------- •-------------------- -------------------- -----------------------------------(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 /> APPLICATION ACCEPTED BY ----- --------------------- -------- - - ------------ DATE--- .- <br /> REVIEWED BY-----_-------------------- -W <br /> - -------- ------------_. DATE ------ <br /> BUILDING PERMIT ISSUED---------------- ------ ------- --------- -- --------------------. DATE ---------�----• . .--- ------------------- <br /> Alterations and/or recommendations: - -------•----------------•-•--------••......-•------- .....---- ------------•-• ..................... <br /> I` ------------•------•----------------------- -------------------------------------------------------------------------------------------------------------------------•--- <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 Korth ,c" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-4-2M 8-51 Revised W-2100 <br />