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3 sem,. <br /> y APPLICATION FOR SANITATION PERMIT Permit No. s ____y <br /> �. (Complete in Duplicate) 7 <br /> Date Issued _1J._' "3 <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 /> / r , 7� t <br /> JOB ADDRESS AND LOCATION..-------��i Iv.. ___ --•------�c l ALZ------.(--.--•--------------------- <br /> Owner's Name - - /� ----:---------------- ------ Phone------------------------------------ <br /> ----- - <br /> Address-----------•-------•------- � __ �'� �..,.. <br /> ------- ---- ----- . ---- ." ---- �_----r - <br /> Contractor's Name --------------------------------------•-----'------------------------------------- ------- Phone----------------------------------- <br /> Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/-____ Number of bedrooms__ Number of baths :/___ Lot size ------- -/�e1 _ ---_.______-_ -_ <br /> Water Supply: Public system [A Community system ❑ Private ❑' Depth to'Water'Teble ---- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe® Hardpan ❑ <br /> Previous Application Made: Yes ❑ No g New Construction: Yes [50 No ❑ ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is a aila6le within 200 feet.) <br /> Septic Tank: Distance from nearest well___ --Distance from found,tion`»"'"Mate lal_-_ 'G_- -------- - ------ <br /> No. of compartments.._____. Size_ Liquid depth- _-, ------------?'Capacity--- �Q_----------- <br /> Disposal <br /> ____ <br /> Disposal �o <br /> 3 <br /> Field: Distance from nearest wgll._.._��-----Distance from foundation----4- __---_-Distance,to nearest lot line_____6.________ <br /> Number bi lines._________ ____- _ Length of each Iine�O_,,A�A -�/Q� %' <br /> ® 9 �r Width f trench-----T-`/ ---------- <br /> Type of filter material___ __Depth of filter material-___._.,L-�________Tot�!length------/_��_�____________ _______ f <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------D.is'tance to nearest lot line--------------- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_{/------.---------Depth--------------------------------- <br /> p tante from fou ._ f' <br /> Cesspool: Distance from nearest well_______________-Distance foundation ___-Lining <br /> ❑ ' Size: Diameter-'-------------------- -------------Depth--.------"-------------- ----Z�---- � -Li uid Capacity----- ---------------------gals. <br /> Ile, <br /> Distance from nearest well-__._-__________________________________________Distanefr <br /> nearest building------.-----_.___________________.._--. <br /> ❑ Distance to nearest lot line_______'______________________.__________--_ *� -------------- <br /> Remodeling <br /> . ,Remodeling and/or repairing (describe)__________________ -- .. � <br /> -----••--•--•--------------------• -----•------------------- ---------------------------------------------------- <br /> --------------------------------------x--------------------------- ---------------------------•----------------------- <br /> t <br /> ---------------------------------------------••--------------------------- -- <br /> --------------------------------- <br /> I <br /> -------------------------------- <br /> I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance/Sfalaws; a ruleand regulation , of the San Joaquin Local Healfh District. <br /> (Signed)--- --- --- ------•----- --- ------------------------------------------ (Owner and/or Contractor) <br /> 8y-------------------- ---------------------------------------------------------------------------------------------------------------(Title)--------------------I------------------------ ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> r FOR DEPARTMENT USE NLY <br /> APPLICATION ACCEPTED BY------ DATE ' <br /> - --• - - -- --- -- -- -------------- -------- ---�-` ---- --�----�-------- <br /> REVIEWEDBY------------€------------------------------- --------------- --------------------------------------------------------- ----- DATE---------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------ ----------------------------------- DATE---=------------ <br /> s <br /> Alterations and/or recommendations-------------------------- ---=------------------------------------------------------°=--=--------------.------------------------­------------------------- -------------------- <br /> (- -------------------. .. .. . �, <br /> -- ----------------------------------------------------••-------------- <br /> -- -------------------------------------•--------- <br /> ---- -------- 1f <br /> FINAL INSPECTION BY------------------- --��- ;:------- - Date-----------� '--- -- ��-----•I-n ------ -- <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 I0-s2 Revised W-2100 <br />