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APPLICATION FOR SANITATION PERMIT Permit\DlGo. <br /> (Complete in Duplicate) _3 - <br /> Date Issued __. _/9 ___.S> <br /> Applica+ion 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. 549. <br /> JOB ADDRESS AND OCATION---------4_-.%- <br /> Owner's. Name------------- -- •----- ........ ---- ----- - - - - ------------------------------ Phone----------------------------------- <br /> Address;--------------------- <br /> - ------------------------- <br /> Contractor's Name----------- - -CJl.rfrf Phone <br /> Installation will serve: Residence @!3-`Apar#ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living _,� <br /> units. _____ Number of bedrooms _,9, Number of baths _f._ Lot size __ _.___ <br /> Water Supply: Public system ecommunify system ❑ Private ❑ Depth to Water Table $41. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �iardpan ❑ <br /> Previous. Application Made: Yes ❑ No P!r'R New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 40Sept•c Tank: Distance from nearest well_ _____________Distance from foundation--------------------Material-_----.-.-_-_____ .-.---..__-----___-._-. <br /> ­—f No. of compartments--------------------------Size--------------------------------Liquid depth--------- ---------------Capacity----------------------- <br /> Dis osal. Field: Distance from nearest well.................Distance from foundation-----------------...Distance to nearest lot line----------___-_-- <br /> Number of lines-----------------------------------Length of each line-----------------------------Width of trench----------------------------------- <br /> Type of filter material._.__..._._____________Depth of filter material----------_------------ otal length-__----_----_-._-----_-__-_---.-----__-__. <br /> SeepagyP4: Distance to nearest well-AVk_A____,_Distance fro foun tion_ _______.Distance to nearest lot line--�/---_ <br /> Number of pits.---- --------------Lining material-e?.-A. ---- ize: Diame#er_.��_`��--_.____Depth----_- -- ----------- - <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_.--__-__-_---..----.-__-.._-----. <br /> ❑ Size: Diameter--------------------------------------Depth-------------------------------------- ----------.--Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest wel#----------------------------------------------- Distance from nearest building____----__._--------_------------------- <br /> ❑ Distance to nearest lot line--------- ------------------- --•-----••-•-•-----------------•---------------------•-------------------•---------------- <br /> Remodeling and/or repairing (describe)_______________ia��/K_*---__.__ -_ <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> /F7(Signed)--------------------- - --- -- -- �hl.�---- . :t ----- {��er e.rs Contractor) <br /> Ely: --------------------------------------------{Title) - �� <br /> (Plot plan, showing size of to ocation of system in relation to wells, buildings, etc., can be placed on reverse e). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- ---- - ----- - - ---------------------------------------- DATE <br /> REVIEWED BY --------- - - ------------------ DATE-------- ---------------- <br /> BUILDING PERMIT ISSUED------ ------- ------- -------------------- ------ -------------------------- DATE----- <br /> Alterations and/or recommendations:------------------------------------------------------------------------- --------------------------------------------•----•-------------------••------------- <br /> ---•----------- -- <br /> .......... --_ _••"=r------------------------------------------ - <br /> - --------------------------------------------------------------------•--------- ---------------- --------------------------------- ------•-----------•----------------------------------•------------------------------------ <br /> .�0 <br /> FINAL INSPECTION BY:.-- - -------------------------------------- Date---- �,L`s--~ <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 /> t <br /> �y <br /> ES-9 145446 GTWnnO F <br />