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APPLICATION FOR SANITATION PERMIT Permit No. k __ _ <br /> (Complete in Duplicate) 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 OrdinerrmnNo. 549. <br /> /! ---------------------------=------------------- <br /> JOB ADDRESS AND LOCATION------------------------------ ___ ------ -••• --------- <br /> Owner's Name -------------------------- <br /> Phone------------------------------------ <br /> Owner's <br /> ;=- - ----------- --- , <br /> Contractor's Name------'------------------------ wl�c�. i- -----------------------------------------------------------------------_ Phone, v- <br /> Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --/- Number of bedrooms _J�_- Number of baths ­-/ Lot size ___1� ------ ----------------------•.-----•• <br /> Water Supply: Public system ❑ Community system ❑ Private Pa- 6epth to Water Table„/A_ ff. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe pan ❑ <br /> Previous Application Made: Yes ❑ No R---New Construction: Yes ❑ No Ra--'—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 /> pt• . Tank: Distance from nearest well----------------- from foundation--------------------Material--------------------------._________---------___-- <br /> No. of compartments--------------------------Size---------------------------_-- Liquid depth--- ----------------------Capacity----------------------- <br /> Disposal field: Distance from nearest `w`ell _-S� _+_':._Distance from foundation_____ _e._.Distance to nearest lot line----------------- <br /> Number <br /> ____��/.._ <br /> -! ---------------------Length of each line---------9-47- r----------.Width of trench-------1; �a-/-„--------------• <br /> Number of lines__________ __ <br /> 6Lz,-__Depth of filter material__-./�_..-_____Total length__'___.S-!_________________ <br /> Type of fi4ter material___�',_ __-____- ------ <br /> i <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 /> [] Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity------------------------•...gals. <br /> Privy: Distance from nearest well-----------------------------_----------------.--Distance from nearest building____=_____.___-----__-_-_______-.-_____. <br /> ❑ Distance to nearest lot line----------------------------- ------------------•-------------------------------------•------------------------------------------------------ <br /> Remodelingand/or repairing (describe):--------- ---------------------------------------------------------------------------- ---------------•- -----------------­­----------------------------- <br /> ---------- <br /> ------------------------------------ ----------- ------=-----------------------------•---------------------------------------------------------•--------------------------•------ -------- y <br /> I hereby "fl-that I have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, tate laws, an rules and regulations of the San Joaquin Local Health District. <br /> (Signed) - �----- -------=-------------------- ------(Owner and/or Contractor) <br /> BY= ----------------------------- -0 ------------------------- (Titles <br /> (Plot plan, showing size of lot, location of system in relation 4o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> DATE_ •-------------------- <br /> APPLICATION ACCEPTED BY------------- ------------ ��` -------------------------------------------------- ----- �----•----- <br /> REVIEWED 'BY------------------------------------- --------------- <br /> ------ ------ ---------------- -------------------------------------- DATE-,-.------------ ---------------------------------------- <br /> ' BUILDING PERMIT ISSUED------------------------------- ------------------- ------------ --------------'DATE------ ----\------- <br /> Alterations and/or recommendations-------------------------- ”' <br /> -- •--•-------- - <br /> -V <br /> _ _______________________________________________________________________________________________________________------------------- <br /> -4A <br /> ________________._-____ __-•_ __!:_-.. _y j....---------------- <br /> ------------- <br /> _____________._ <br /> r _ __ _______________ _... <br /> ---------------- -------------------- ---------I------------------------------- ------- --------------------- - <br /> ---- ----------------------- -•---------------- ---- --- --- -------------- -------------- ------ <br /> ----- ------- <br /> ------- ---- ----- - ---- - - -------- <br /> FINAL fNSPEC�TION-•B ------- -- ---------- Date 1�_ y % <br /> r <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 Manfeca, California Tracy, California <br /> n ES-9--2M . Pevisea.,1-57 F.P.CO. <br />