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173 <br /> APPLICATION FOR SANITATION PERMIT Permit -------- <br /> (Complete in Duplicate) <br /> Date Issued1-6 <br /> -- ---- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin desc * ed. <br /> This applicafion is made in compliance with County Ordina e o. 549. <br /> JOB ADDRESS A CATION <br /> --- -- ------------- - - <br /> Owner's Name- --- --- ---- --- - -- ----- - - --- -------------- --------------------------- -------------------- <br /> ----------------- Phonej5;/------ <br /> Address------------- <br /> Contractor's Name--•------------ ------------------------------------------------------------------------------------------ Phone_-- <br /> Installation will serve: Residence Apartment House E] Commercial El Trailer Court [3 Motel E] Other E] <br /> - <br /> Number of living units: -- --- Number of bedrooms.._ Number of baths --/- Lot size jF?!!V_*1,:;?— ——------------- <br /> Water Supply: Public system E] Community system [] Private Depth to Water Tablell��-:P ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay 0 Adobe Hardpan [3 <br /> Previous Application Made: Yes E] N OX New Construction: Ye4r,No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiff ed if public r is available within 200 feet <br /> Septic Tank: Distance from nearest well <br /> istance from founclati� ---- ___-Materia(,49-2-1!�*T:K ell ,,.e, <br /> ---- -- - ------ <br /> No, of compartments ------ -_Liquid depth---00 gal:5�----capacity- <br /> well <br /> Disposal Held- Distance from nearest well isfance from founda_f4ion --' --- Distance to nearest [of lin _41_ <br /> ....... _ __ - / <br /> L� .. .. . ....... I - 0 <br /> Number of lines_____________------- - -----Length of each line--- Width of trench--- <br /> Type of filter material - ------ --- _____Depth of filter material___ -------Total length----P <br /> --------------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____-_--___-_-__ <br /> ❑ <br /> ine----------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth-------------------------------- <br /> Cesspool: - Distance from nearest well_________________Distance from foundation------------------- Lining material-------------------------------------- <br /> ElSize: Diameter--------------------------------------De th----------------------------------------------------Liquid Capacity---------- -----------------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line------ ------------------------------------------------------ <br /> Remodeling and/or repairing (describe):------------- ----------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------- -------------------------40 <br /> ---------------------- -------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> *---------------------------------------- <br /> I hereby certify A + I have pepared this application and that the work will be done in accordance with San Joaquin County <br /> a' <br /> r, <br /> ordinances, Stafe , and rul ndd egulations of the San Joaquin Local Health District. <br /> (Signed)- _---- -- <br /> -- ------------------------------------------------------------------------------------------------ (Owner and/or Contractor) <br /> By---------.....----------0 --A-----•- ----------------------------------------------------------------------------------(Title)- -1!11_ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pfa-c-'ed on reverse sidel"' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- D AT E!O_'--APPLICATION ------------------------------------------------- <br /> REVIEWEDBY------------ ---------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUEDDATE----------W i� <br /> ----------------------------------------------------------------------------------------------------- - <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------------ <br /> ----------------------------------------- ----------------------------------------------------------------------------------------------------------------------------_------------------------I--------------------------- <br /> ------------------------• •--••------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- <br /> -----------I-----------------------------------------------I--------------------------------------------------------------------------------------------------------------------­- <br /> ------------------------------------------ <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------1-1------------------------ <br /> FINAL INSPECTION BY:--- r ---------- Date-------- <br /> - --- -- ------- -------- -------------------------------------- <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-9-2M 8-51 Revised W-2100 <br />