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1� ✓ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... ...... .. ..... <br /> (Complete in Duplicate) <br /> Date Issued __.-- -,. .. <br /> A plicaa-ion is hereby made to the San Joaquin Local Health District for a permit to c str and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 49. <br /> ---------------------- <br /> JOB ADDRESS AN L5CATION-------------- � = -- -- <br /> ------------•--------- <br /> Owner's Name-.. �.� <br /> Address........... -7--- -------------- -- --------- ----------------- <br /> Contractor's Name---------------------• --------------------------------------------------------------- ------------ Phone-----•---------------------------- <br /> Installation will serve: Residence Apartment Douse E] Commercial E] Trailer Court F] Motel El Other El <br /> Number of living units: _ __ Number of bedrooms.2__ Number of baths .---- Lot size _--- ,aC/ ---h------------------ <br /> Water <br /> ______________Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tab[� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g la pan ❑ <br /> Previous Application Made: Yes ❑ No �ew Construction: Yes kj--+16-0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> aseptic ank: Distance from nearest well-----------------Distance from foundation--------------------Material__--._------..._--..___----_---_-----.-..._--_.-. <br /> v ' ' No. of compartments---------- ----------Size-.--•----------------------•---Liquid depth--------- ----------------Capacity------- -----------.._. <br /> Disposal field: Distance from nearest weli.................Distance from foundation--------------------Distance to nearest lot line--__--_-_---__--- <br /> - Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material----------------------- length.__._---_------.-_---..__ <br /> Seepa�9e Pit: Distance to nearest well_4'�_ -- -_-_--Distance f�_ 'T1.7.Size: <br /> dationAia <br /> .........Distance to nearest lot li �___.._ <br /> ® Number of pifs.., - Lining materiah, eter.-„?,------ --------Depth------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.-..------------------------------- 0 <br /> 11 Size: Diameter-------------------------- -----------De th----------------------------------------------------Liquid Capacity- -------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-._.-._---_-___--_-__-----..--..-----. <br /> ❑ Distance to nearest lot line--- ----------------- --------- ------------ --------- ------------------ ---•--------------- <br /> Remodeli or-repairing (describe):__ � � -/�/ ='"r - -` ” <br /> �.r <br /> --------­------------- ----w-, <br /> -- <br /> --- -� ----------------------------------------------•--------------------------- - ....�..........---------------------------------•------------------------ .1----------------- -- <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 /> ordinanc:ax <br /> ules and regulations of the San Joaquin Local Health District. <br /> (Signed)_ __ _________ - _.(Owner and/or Contractor) <br /> By: Gf (T'itle) - <br /> ---- --------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pKced reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ------ ------------------------------------- ------------------- DATE--------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------ ----------------------------- DATE--------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------- --------- ----------------------- DATE <br /> - - ---------------------------- <br /> Alterations and/or recommendations:------------------------------------------_---------------------------------------------------------------------------- -.._------------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------------•---•- .............. <br /> ---------------------------------------- ----------------------------------- ------ - ----- -- •----------- ------------- ------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY------------- - / -• �-----•- - - Date__ ---• ----- ---✓- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Americen 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 145446 ATW000 12-S4 <br />