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APPLICATION -FOR SANITATION PERMIT Permit No. ._-___ _ <br /> .(Complete in Duplicate) <br /> J Date Issued -6/7t <br /> Z <br /> istrict for a permit to construct and install the work herein described. <br /> tApplication is hereby made to the San Joaquin Local Health D <br /> This application is made in compliance with County Ordinance No. 549. <br /> - ---------� -- --- -- <br /> JOB ADDRESS AND LOCATION---------- - � ---•--------------------------------- --------------------------------•.--- <br /> Owner's Name --------------------- --------------- Phone------- <br /> -------------------- <br /> Address----------------- ------------------------------- <br /> - - ---- ------- <br /> Contractor's Name 4 - Phone <br /> �. <br /> Installation will serve: Residence artment Hou e ❑ Commercial E] Trailer Court ❑ Motel ❑ Other [I <br /> Number of living units: ._-- Number of bedrooms _______ umber of baths ___f___ Lot size _________ V� -- -=�•- <br /> Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sa d4�]'' Gravel ❑ Sandy Loam ❑P Cla ,�Loarn-F-1--lay C] Adobe Hardpan ❑ <br /> Previous Application Y ❑ New Construction: Yes No ❑ <br /> Pcation Mae: es o <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__y_ _tstanc from founds ion-____1_9_______Materi rl- ________ <br /> No. of compartments---------_`7/'_._---_Size----4�_5lt---Liquid depth----------ii�---.----------Capacity----- -4�i --- <br /> Disposal Field: Distance from nearest well/14r"`!-Distance from foundation----- _0___7__Distance to nearest lot line_l,__ -------- <br /> Number of lines----------------- Length of each line_--0- �----__.j ----Width of french-_____ --�r_� ______ ____-- <br /> it� • " -----Total length---------- -- ----- ----•- <br /> Type of filter material__ `___ FDepth of filter material----- - <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______--_-_______ <br /> ❑ Number of pits----------------------Lining material------------------ Size: Diameter-----------------------Depth-,------------------------------- <br /> Cesspool: Distance from nearest well------------- --_ Distance from foundation___________________ Lining material------------------------------------- <br /> 171 <br /> ---- _________________❑ Size: Diameter--------------------- --=-------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest wO------------------------------------- ----------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------------------ ---- -------------------------------------------------------------------------- <br /> Remodeling and/or repairing describe):------------------------ ------------------- ------------------------------------------------------- <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 /> ordinances, St 1 ws, an rue rid-regulations of the San Joaquin Local Health District. <br /> ------------------ <br /> -------------------------------------------(Owner and/or Contractor) <br /> (Signed) <br /> ---------------------------------------------------- <br /> i <br /> - ------- --------------------------------------------------------- <br /> Title <br /> (Piot 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 />! +,�tLICATION ACCEPTED BY------•-------------------- -------6----- ----- W------------------------------------------ DATE--------------6-------4�-------- <br /> REVIEWEDBY----------------------------------- ------ ------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-------- --------------------------------------------------------- <br /> -------------------------------- <br /> ---­1---------•----•-------------------•------------------- <br /> ------------------------------------------------------ ----------- ------------------------------------------------------------------- <br /> -----------------------------------------•----------- <br /> ----------------------------------- <br /> --------- <br /> - --- - - -- -------------------------- <br /> - --------------- <br /> ZbOCAL <br /> ---------- --- ---------------------------------- ----- - <br /> ------ Date----- <br /> FINAL INSPECTION BY: -----------------•------- <br /> SAN JOAQUIN L HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> i' <br /> ES-9-2M 8-51 Revised W-2100 <br />