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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> I <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, <br /> 549. <br /> JOB ADDRESS AND LOCATION---• <br /> Owner's Name------------------------------------------- --.-------1i�: _d_!- _f_:------------ - - ------------------------- Phone------14•v-t7-a------------- <br /> Address-------------•----------------------------•-- - ji <br /> 1 -------------------•-------------•-- ---------------------•------------------ <br /> Contractor's Name---------------------------------- -`----------------------------•--- Phone...... --=--14-R-7------ <br /> f-ii <br /> Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___/_ Number of bedrooms _y___ Number of baths _ ___ Lot size --------1—Q_ ._3St----/__94----------------- <br /> Water <br /> -_---_- ______Water Supply: Public system .M Community system '❑ Private ❑ Depth to Water Table � ft, <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobejK Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) } <br /> Septic Tank: Distance from nearest well_l�_Distance from founPatt+on__/R ------.Material-- .c.l <br /> c�-�1` ..........compartments _44 <br /> Size '----- <br /> Disposal Field: Distance from nearest well &"-_Distance from foundation--- --------Distance to nearest <br /> rue <br /> Number of lines_ __.________L__�_.--_ _ _ Length of each line,----�-Ez___''_______-Width-of french---_c___C__r�`_' --- ---------- <br /> Type of filter material___/_�,�_. ___Depth of filter material----- _S'"-----Total length------�,_[?''"_________________ <br /> Seepage Pit: Distance to nearest well---l'l_*C�-__Distance from fou dationz.'�_ _____.Distan Distance to nearest lot line___-_ ..__ _ 0 <br /> f O� <br /> [ Number' of pits________----------Lining material_ _u -'Size: Diameter......c3_3_ ____.Depth___cZa---____. <br /> nce from <br /> ning <br /> Cesspool: SDizeabiameter nearest well________________Depth�e from foundation=-=---____.________-Lilquid Capacity gals. <br /> p tY <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 /> ------------------------------------------------••------------•-•--•--------------------------------------------------•--•------------------------------------------------------------------••----------------------- <br /> a <br /> ------•---------------------------------------------------- --------------•-------------------------------------------------------•------------------------- ------------------•---------------------•------------------- <br /> hereby certify that I haver- pared this appli tion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules a d regulations o he San J-a quin Local Health District. <br /> (Signed �—�/ �-/� #t �,aa 6t"ot <br /> - 11 <br /> ( r Contractor) <br /> BY: ------ ... ------------------------------------------- -----------------(Title)- -- ----------------------------- <br /> (Plot plan, showInd size of lot, location of kystern in relation to wells, buildings, etc., can be .laced on reverse side). <br /> ) <br /> .i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY = -------------- DATE---------- 1 .¢" <br /> REVIEWED BY ----------------------------- -- ----------------=-------------------- DATE <br /> �i <br /> {" <br /> BUILDING PERMIT ISSUED-------------- ---------------------------------- ----------------------------------- <br /> DATE <br /> --- - ---------------------- <br /> Alterations and/or recommendations: -1i <br /> ------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------=--------------------- <br /> J. <br /> a <br /> N <br /> FINAL INSPECTION BY: Date- <br /> --------- <br /> --------------------------- <br /> ate-------- � �—�I � <br /> 1 1 <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 8-51 Revised W-2100 <br />