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APPLICATION FOR SANITATION PERMIT Permit No. ._._r�. __I_ <br /> (Complete in Duplicate) 3� <br /> Date Issued _____ <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 <br /> CATION....--= ��-=-- > -�` ~� lY- - U—' .- --------- <br /> JOB <br /> 3`� D� <br /> r '---------. _.. -- - <br /> Owner's Name------- <br /> __ .- o`----------------------------- ------------- Phone <br /> G <br /> Address---------- • --•---------- `� 1 �' ------------•-------------•----....---•----•-----------------------•--•-------•-------------•------ <br /> _ <br /> Contractor's Name-------- -- ------------ ----------• ---------------------- Phone.-AZ---- <br /> A <br /> Installation will serve: Residence 2-- <br /> House [I Commercial E] Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units:/---.- Number of bedrooms -Number of baths _ .-_ Lot size ----- d----�------ ------------- <br /> Water Supply: Public system [vy`Community system ElPrivate ❑ Depth to Water Table -<--Bff. <br /> Character of soil to a depth of 3 feet: FSand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [--] Clay ❑ Adobe RL Hardpan ❑ <br />! Previous Application Made: Yes ❑ No 2-- 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 /> Septic Tank: Distance from nearest well_.- _ l-_1d]* tance from <br /> (� -- �_- foundation_..,C _-'-t.:..Material-_. <br /> No, of compartments------ ------ ---Size-- _ �-- Liquid deph---------0_: Capacity <br /> -------.CaPacity---- <br /> ... <br /> ------�4p-7__-_-- ~ <br /> Disposal Field: Distance from nearest well__/4` istance from foundation__-/&--------Distance to nearest lot line,--,fQ._---_. � <br /> Number of lines----------�.-..l_..�------------Length of each line------- 0___.f�.....Width of trench_..___ _ __-.___________ <br /> Type of filter material---I- _---rj. -Depth of filter material----/. ...--__...Total length--------VL9------------------- <br /> ---- f <br /> Seepage Pit: Distance to nearest well--.-L✓&Ilt isistance from founda ion____ /I <br /> Seepage to nearest lot line_____r�?r. <br /> r ------Linin material__✓ 1 + Diameter---- r f <br /> Number of pits.-- - ----- 9 -- -- - -- ----- -----Depth - ��7�---'-------..._ <br /> Cesspool: Distance from nearest weld-----------------Distance from foundation--------------------Lining material--------------------_-_-_.__------._-. <br /> ❑ Size: Diameter---- ---------------------- - -------Depth----- -------- ---------------------------- --------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ` <br /> 3 ❑ Distance to nearest lot line- ----------------------- - ------------------ --------------------------------------------------------------------------------------- <br /> Remodelingand/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, Stat S. and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-------- -------- --- --•• -- --- -- ''V-----y--- --- - --- - ------------------------ --------------------------------- <br /> --------------------------- -----(Owner and/or Contractor) <br /> By:. --------------- -----(Title)------ --------^---- ----------------- <br /> (Plot plan, showing size of lot, Iocafion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY_,_Ie�*------------- ---------- - ---------•----------- ------------------------------------------- DATE----- . .-.----....------------------•--------------------- <br /> REVIEWEDBY------------------------------ ° -----.------------- -------------------------------------------------------------, DATE---�_-------•-------------------------------------- <br /> BUILDINGPERMIT ISSUED------------ ------------------------------------------------••---------------------- ------- -------- DATE-------9-N------------------------------------------------- <br /> Alterationsand/or recommendations---------------- ----------------------- ----- ------••--------------------------•--------------- -------'---------------------------------------.--------- <br /> _ - J __. ----.. _ - ----------------------------------------------------------------------------------------- <br /> --------- <br /> �-� 1 <br /> ------------ - ------------------ <br /> ------------------------------- ----------­­-------- ---•---------------------------•------------- ------------------------------ <br /> t - �,j <br /> FINAL INSPECTION BY_____________________________ <br /> ------•------------------- Date.------ --------------------------------------­---------------------------- <br /> SAN <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 /> /5-9-214 145446 A'1I 00D 1254 <br />