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APPLICATION FOR SANITATION PERMIT Permit No.1 Z I �..._.-- <br /> (Complete in Duplicate} �/ <br /> } <br /> Date Ensued ._..-'��.[--�--.. <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN OCATION............. <br /> Owner's Name...... .. ....... -•---•------.._._..--••-------.....------•--- ....-------•......._.._...__... Phone------------------------------------ <br /> Address-----------. , N C'_r .�............. <br /> Contractor's Name �f'� f-------:r-..----`—C�1 —:_.................................................. Phone................................... <br /> Installation will serve: Residence [--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number Number of bedrooms _._7�Number of baths l_.... Lot size ...... ....................... <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table CIO-e. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No V�_. 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._..-----------Distance from foundation-------------------.Material........ <br /> ..__.__.___.._._._..- <br /> ❑ 2 c of compartments............. -...... --Size--------------------------------Liquid depth..........................Capacity....................... <br /> Disposal Field: 1).is#ante from nearest well................Distance from foundation....______..____.__.Distance to nearest lot line................. <br /> ❑ of lines-------------------.------------------------------------------Length of each line_-------_------------._ --...Width of trench................................... <br /> T e os filter materieL........................De Depth of filter material ------Total length.......................................... (� <br /> Seepage Pit: Distance to nearest well... Distance from found,Iption....../L1.......Distance to nearest lot line---Y�._..___ W <br /> Number of pits...../..............Lining material...�.CiC_�._Rize: Diameter__. ~. <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 /> Remodeling and/or repairing (describe)=....... ----•----------•-------------- ---------•--.._........••••-------- <br /> ......................•---------- -••-•--•--•--------------•---••----------•--••--•-----•-••-----------_............................I..............•-••••••................................................................ <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-14 aPd rules and regulations of the San Joaquin Local Health District. <br /> ��............... D ----- .: --- �--_------------------ ---•---- ..._. ------'.(OJwner and/or Contractor) <br /> L. <br /> By:, �. � lF��► L lam: x; �---------------(Title)--..-. � f....................................... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY....................... ......... DATE DATE........ <br /> .................................•-------- <br /> ....... <br /> REVIEWEDBY---------------------....................................................... ----------------- ---------•-----•-- •---•---------. DATE---------------�. <br /> BUILDING PERMIT ISSUED..................... .... --------------------------------.........-..---------- DATE------- -------- ------ <br /> Alterations and/or recommendations:................... .... ................... ..................-.....-... .-....-.---.... . <br /> = � ---------------------- <br /> ......... . 5 ......... ............................................... ................................................ _----------­------------------ <br /> ... <br /> ------------------- .... ..--------------------------------------------- <br /> ..............................................................----------------------------- <br /> / )i �� <br /> FINAL INSPECTION BY:..i.. ............ ........ Date_..../-. .. .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Sfreet <br /> Sfocktoo, California Lodi, California Manteca, California Tracy, California <br /> r5---9-2M <br />