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APPLICATION FOR SANITATION PERMIT Permit No. ....1._T../ ,fir 0 � <br /> ` [Complete in Duplicate] <br /> ------------ ------- This Permit Ex ices 1 Year From Date Issued 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 Ordinance N4. 549. <br /> JOB ADDRESS AND LOCATION. ..'_____ 47 1_ W� <br /> -------------------------- <br /> Owner's Name /�-!p � ------..,�.-----_ <br /> Phone <br /> Address---------------- ��3' i <br /> T� <br /> Contractors Name- ----------- '-- ------------ Phone. <br /> ------ <br /> - - - -------------------------- <br /> Installation will^serve: Residence U3---Apartment !-louse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> rZoNumber of living units: I------- Number of bedrooms .3____ Number of baths __f:_-_ Lot size ----------------------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ ! Depth to Water-Table,j�0 ft:' <br /> Character of soil toepth 3 feet : and ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [J` Hardpan ❑ <br /> Previous Application Made: (If yes date_'f->27_ ; ---] No ❑ New Construction: Yes No <br /> i ❑ Ej�_ 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 /> Sept' and : - Distance from nearest well----------------- from foundation------------------- Materia{___.__±____.__-_ _ ___. <br /> ! - -- ----------------------- <br /> No. of compartments-------------------------Size--------------------------------Liquid depth--------- ----------------Capacity <br /> Disposal Field: Distance from nearest well.... Distance from foundation-M----------------Distance to nearest lot line: /------ <br /> L� Number of lines-----t-------------- ---- --------Length of each line---.6.0-------r---------..Width of •-------------_--__ s <br /> Type of filter materialf9 __--_Depth of filter materiaL_t - -____. <br /> Total length = ---------------------------- S € <br /> Seepage Pit; Distance to nearest well...~-___-.......Distance from foundation__k-,-_- Distance to'nearest lot line_37�- J <br /> Number of pits.-I- <br /> ------------------Lining maferial_�L-4------Size: Diameter.c�c?- ----- Depth__.-n�" <br /> Cesspool: Distance from nearest well---------------- Distance from foundation._____--------------.Lining material-------------------------------------- <br /> 171 <br /> ____..___-------,___ .❑ Size: Diameter ----------.Depth----------------------------- ----------------------Liquid Capacity----------------- gals.dl <br /> Privy: Distance from nearest well----- <br /> ----------------------------------------_-Distance from nearest buildin <br /> g--------------------------------------- <br /> ❑ Distance to nearest lot line_______________________________ <br /> -R--e--m---a--d--e- l'n and/or re-pai�g (describe) f: -"��"�-�*---��- <br /> e <br /> ------------------ R. <br /> ------ --•-------------------------------- <br /> -------------------- <br /> - - <br /> -- -- -- - -- - <br /> ------------------------ ------- --- -------------------------------- - ---------------- ---------------------------------------------- -- <br /> ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State d rules a re la+ions of the San Joaquin Local Health District. <br /> (Signed) a-._ - - --...(Owner and/or Contractor) <br /> - ----------------- <br /> By:------------------------------------------------- ------------------ ----- --- <br /> - - - -- ---------------------------------------------(Title)--------- ---------s- �- - - �- <br /> - - -------------------- <br /> [Piot plan, showing size of to}, Iota+ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> S. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------4� /---- ----- - - R �` Ev <br /> DATEREVL ------------=- <br /> IEWED BY -------- -------- DATE <br /> ..BUILDING PERMIT ISSUED----------•------------------------------------ - ------ DATE <br /> ---------------------------------- <br /> Aterations and/or recommendations_____________________ <br /> ----------------------------------------------------- <br /> --------=-------------------------------------- <br /> -------- ----------------- ------------------------------­­ <br /> .............. -------:---------- - <br /> -- -------------------------- <br /> FINAL fNSPECTION BY:---- - - -- -------- ---- ... Date--------�� 1f19 —------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.lla:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California t Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />