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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date Issued ---- <br /> This Permit Expires 1 Year From 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. S49. <br /> JOB ADDRESS AND LOCATION------- ( -``----f- ------- 1---- .-------------------------------------------------------------- <br /> i <br /> Owner's Name--------- ------•A__:Q-c--- r r r �----------------------------- -------------- ---.-- Phone----•----------------_---- <br /> Address-----------------_---2_10_`.... .. <br /> Contractor's Name---------------------- ---V!, -------------------------------------------------------------- ---------------- Phone----•-----------•-----•------------ <br /> Installation will serve: s Residence [�partment Hous ❑ Commercial ❑ Trainer Court ❑ Motel ❑vv Other ❑ <br /> Number of living units: J-.-- Number of bldroortis _ Number of baths -__I_... Lot size -------- --------------------- <br /> Water Supply: Public system ❑ Community system +❑ Private DKIbepth to Water Table 90 ft. <br /> Character of soil to a depth of 3 feet: l Sand ❑ I GraV'el ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <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 /> Septic nk: Distance from nearest we'L.__� '_1_Distance rfrom foundation-.-10-------.Material-__---Gd �Cl'L� / '°� <br /> [ No' of compartments....,,__.._z_. Size-- IR- Liquid depth------------ -------------Capacity---�Q_Q----• <br /> Disposal ie1d: Distance from nearest welL_S- -...!Distance from foundation d...-.. . Distance to nearest lot line-_51- <br /> Number <br /> ine- 5..Number of fines--------- .- Length of each line---- j r�Width of trench---_ L ---------- <br /> Type of filter material- a;'�:_�`¢�� Depth of filter material_.-,.-.$..........Total length--------- -------------------- <br /> Seepage Pit: Distance to nearest-Well------------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits-------------- ------Lining material-----------........(---Size: Diameter-----------------------Depth--- ---------------------------- <br /> - i <br /> Cesspool: Distance from nearest well-----------------Distance from fouHation-----------.--____Lining material-__.__...-- ----.-.-..--..__--------- <br /> ❑ Size: Diameter- -------1__._____--------- ------- Depth------------------- -----------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest Well--- --.-..-I-______________________._------ istance from nearest building------------------------------------------ <br /> Distance <br /> .......-.--- ..-_------_---------------- <br /> Distance to nearest lot line----- < - ---------------- ----------------------------------------------------= <br /> T %� i <br /> Remodeling and/or repairing (describe):------------------------i-_------------"'""'"" <br /> -----------•------------------------------------------------------- ---------------------------- ------------------------------------------------------------------•----------------------------- ----- ------------- <br /> ------------------------------------- -------------------­--------------- ----- <br /> ---------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------------------------------- Al <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, State laws;and rules and regulations of the San Joaquin Local Health District. <br /> • i <br /> (Signed)-•- ------- - <br /> -(Owner and/or Contractor) <br /> BY ---------------------------- ------------- -------------------= {Title} <br /> (Plot plan, showing size of lot, location 3 system-in,relation,ta..wells, buildings, etc., can beplaced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -------------------------------- ---t-.I:: -4 G c <br /> - --- ------------ DATE--------- C7- �'� <br /> - -------------------------- <br /> REVIEWEDBY--------------------------------------------- ---------------------------------------- ------------------------------------- DATE <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------- <br /> ---------------------------------------- DATE <br /> Alterations and/or recommendations----------------------------- ---------------------------------------------•---- ------------------------------------- ------••---------------------------- <br /> --------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----- -------------------------------- --------------------- -------- -------------------------------------------------------------------------- ---------------------------------------------------------- ------------- <br /> ------------ ----------------------- ----------------------------------- ------------ --- --- ------------ ------------------------------------------------- ---------------------- <br /> FINAL INSPECTION BY----------- ------ ?j �� <br /> 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-9-7M Ro; ed <br /> a �p v <br />