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APPLICATION FOR SANITATION PERMIT Permit No. ......... <br /> (Complete in Duplicate) Date Issued <br /> App rlcati�onis ereb made' to the San Joaquin Local Health District for a;perml o construct 4and ' tall the work herein described. <br /> eo m <br /> �J.� k ounfl Ordinatce No. 549, <br /> This application is a in com nc <br /> .1.. . . ............. . ..........Z_ ------------ <br /> -- ---------------------- -- ---------- ------------ -------------- <br /> JOB ADDRESS OC TI --- ----0-------------�4 <br /> ---- Phone- -Owner's Name------- --------------------- ---------------- ------------------------------------ --- <br /> Address-------------------- --- ------------------ ------------------------------------------------------- <br /> .1 � <br /> Contractor's --------If--- ------------------------------ Phone A_ <br /> Installation will serve: Residence UT-_A�partmenf House F Commercial E] Trailer Court [3 Motel [] Other E] <br /> Number of living units: Number of bedrooms _l�Number of baths _/__ Lot size ---------------- <br /> Water Supply: Public system V-1c,"ammunity system El Private F1 Depth to Water Tab),5V ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam [] Clay [] Adobe e Hardpan <br /> Previous Application Made: Yes E] No w Construction: Yes Ej No E] FHA/VA- Yes Ej No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> !a <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> LTI nle.— Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- <br /> 1--1 No. of compartments--------------------------Size------_-----------------------Liquid clepth--------------------------Capacity----------------------- <br /> la� vtrla I F' •Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--_----------_ <br /> Number of lines----•------------------------------Length of each line-----------------------------.Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length-----------------------------------------­ <br /> Seepage Pit: Distance to nearelf well-- ------Disfanchfror� foundation-157.-op_Distance to nearest lot line_,_,A:F <br /> jj;;OK�'; p Number of pits---- ----------------Lining material- -—---------Size: Diameter-J.3, ------------Depth-A4----------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------- _-_--lining material------------------------------------ <br /> P Size: Diameter-------------------------.-----------� Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance- from nearest building-----------_------_--_-_----.___-___------ +�+ . <br /> ❑ <br /> uilding-------------------------- ------ <br /> El Distance to nearest lot line------------------------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------I----------------------------------------------------------------------------------­­----------------------­­1----------- <br /> ----------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------- ------------ ------------------------- ---------- ------------------------------------------- --------------------------------------------------------------------------•-----•--------------------- <br /> I hereb cerci that I have prepared this appl cat and that the work will be done in accordance with San Joaquin County <br /> il and <br /> ordinances, a aws, and le and regulations of t e. San J, qui al Health District. <br /> (Signed} ------- ---------------------------- ---------- ------- --- - ------------------------ ------ -------• Contractor] <br /> ------------------iTitle --- -------- ------- <br /> 8 ----- -- ------- ----------- . . ........ . <br /> �u. <br /> 'i�. <br /> --------L , S 5n reverse-- - --------------------------- -------- --------- --- ------ - <br /> (Plot plan, showing size of lot, location of system in re ti in to wells buildi s, etc., can be P ce on reverse side), <br /> FOR. DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------ <br /> -----------------------------•-----------------------------------• DATE---------------------Z 6_9--------------------------- <br /> REVIEWEDBY------------------------------------------------------- ------ - ------------------------------------- ----------------- DATE-------------- - -------1--!---•-------•--------------- <br /> BUILDING <br /> ---------------------------BUILDING PERMIT ISSUED------------------------------- -- ---- --------------- <br /> ------------------------------------------------- DATE--------- <br /> ATE-----------------------/--------------------- <br /> ----------------------------------------------------------------- <br /> ----- <br /> --------------------------------------- <br /> Alterations and/or recommendafions:-------- ---- -- -- - - ----------------------------------------------------------------------- - ---------- ----------I----------------I-------- <br /> --------------------------------------------------------- -------------- - <br /> ---------------------r- <br /> - - ------- ----- - - ----- - a ---- -- --------- ----- -- --------------------------- ----------------------------------------------------------------------------------------7------ <br /> -------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION Byg_,i--—------ Date.... -----------------------------------------• <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sfraef 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2M Revised 1.57 F.PrCo- <br />