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APPLICATION FOR SANITATION PERMIT Permit No. ..............------ <br /> (Complete in Duplicate) "�1"�'"" ` <br /> 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 No. 549. <br /> 1 11 ] <br /> ��JOB ADDRESS AND LOCATION esO ----—--------------- --------------- <br /> - .4FPPhone Name---------------•--•--------- ---- g - o--,49W-4 ----- <br /> Address------------------------------- 11 -------------------------------------------- <br /> _�i2'1$---------•----- ------------------...-.------------------------------------------------ ------------------------------------------... <br /> Contractor's Name - 1 -----------------•--•--------------•-------- Phone--4jP.-- 6-9-(6• <br /> Installation will serve: 'Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units __�__._ Number of bedrooms _y'�„s_. Number of baths __�___ Lot size Q_�-- ------�. �_______________ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 14 ft. <br /> Character of soil to a depAtf 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: iYes ❑ No UK" New Construction: Yes ❑ No 0"Rep1 e Mtgr1] �f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu6lic sewer is available within 200 feet.) �? <br /> � . y � <br /> tit T nk: Qistancetlifrom nearest we110__.______Distance from foundation----- <br /> No, of compartments-._.--. -Size �� " °� <br /> r` - Gquid depth CapacitY Pdt / <br /> Disposal Field: Disfance:from nearest well f'7s_.____Distance from foundation_._._�_�..�__Distance to,nearest lot line-- <br /> ---------- <br /> -A"A" <br /> ine__ <br /> Number-of lines__--_._I________________.._______Length,of each line-_�_��___-._____---_.Width of trench_: - �..� <br /> TType ____.-_Depth of filter material---.-_______' <br /> e or:.filter material---------------- Total length F?----------------------------t+-"• <br /> i . Distanc <br /> Seepage Pit:- Distance,to nearest well__�__QQ____.____Distanc fr m foundation- _____.___. o nearest lot line___________.. <br /> "- Size: Di meter_____ <br /> Nurnber�of pits.----�---------------Lining materia#_ _ _-� -- � ------ - p %S7---------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation.--. ___._-__._. ining material-------------------------------------- <br /> ❑ Size: Dil�meter---------- -----------=--------------Dept h---------------=-t--------k"� - ...Liquid Capacity gals. <br /> Pnivy: Distance-from nearest well-------------------------------------------- __Distance from nearest buildin . ______________-_-------.:. <br /> ❑ - Distance`.to nearest lot li .-=----- ----- <br /> C Remodeling and/or repairing <br /> a (describe : <br /> ------------------------ - ---- - <br /> -------------------- <br /> : C ----------------------- ---------------------------------------- <br /> E - 4 <br /> - <br /> ------------------------------------- ----------------- - ------------- <br /> I <br /> here6y r+ify that I have prepared this apAcaMin and that the will be done in accordance with San Joaquin County <br /> ordinance$, a laws, and ekes an rejula+io °of the San JoaquincL'ocal Health Distric+. <br /> (signed)------ <br /> By: <br /> ' - - �•- --------- ---- - -- --�----------- ---- - = ---- --- [ r Contractor) <br /> ---------... y <br /> By:--------------- -•-------------------•--------� ------------------------ - Ti+le)- �5' -/_t_'�L-U -�.1-'----------------- <br /> (Plot plan, showing size of to+, location of system in rely to wells, buildings etc., can be placed on reverse side). <br /> ,w "FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEI TEp�BY__ �.. { <br /> ------------------------ ------------ ---------------------------•------------------------ DATE..�---------------------------------------------- - <br /> REVIEWED BY----------------------.j- <br /> Y------------------------------- -- ---- . --=------------------------------------- bATE----U ------------------------------------------------- <br /> BUILDINGPERMIT ISSUED.L---------------------------------------------------------------------------------------------------- DATE.. - '. =----------------------------------------- <br /> Alterationsand/or recommendations:-----------------­­--------------------------------------• ----------•---------------- -•--------------------------..........--- ---••--------------------- - <br /> I ----------•-----------------------------I-------------------------------------------------------•----------------------- ...----. .............................................. <br /> ,Ip. <br /> ----------------------------------- <br /> -------------------------------------- ------- ------------------------ ------ --------------•-- ----------- ---------------- ---------------------------------------------------------••--------------------------------- <br /> FINALINSPECTION BY -------------------------------------------------------------- Date------------------------- •- <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 ; IRevised W-21,00 <br />