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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica4ion 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_Ordinanc . 549, <br /> JOBADDRESS AND LOCATION------- - ---- ---- ----------- ------------•----------------------------------•---------------------------------------•---------- -------------------- <br /> Owner's Name------------------ - P,rJ------ ----'--- ---- ----- Phone <br /> Address----------------------------------- - ---- --- Y%110-- ---------------------•-----------------------­­ ----------------------------------- ­----------------------------- <br /> Contractor's Name -=�1'YL�"' --------------------------------------------------------------------- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _I-✓-- Number of bedrooms _Number of baths A-___ Lot size --------- ------------------ <br /> Water Supply: Public system_ Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑� <br /> Previous Application Made: Yes ❑ No`� New Construction: Ye No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-_,_______________Distance from foundation_________________ Material____._______.____..__-.____________.._______.__. <br /> ❑ No. of compartments------- - - -----------Size--------------------------------Liquid depth---------- ---------------Capacity-••----------------- <br /> Disposal Field: 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 nearest well_----------------_---Distance from foundation------------------.Distance to nearest lot line_-_-______-___._ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diametej-----------------------Depth----------------------- ------ <br /> C s L• Distance from nearest well__ _.____-_ Distance from ound _._ation ---/ Lining material__._ <br /> Size: Diameter_-- l� -----------Depth "( � � - Liquid Capacity gals. <br /> Pr Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------______- <br /> ❑ Distance to nearest lot line----------------------------------- -----------------------------•- •-__---------------------------------------------------------------- <br /> Remodeling <br /> • •--------•------------------------------------------------------- <br /> Remodeling and/or repairing Idescribe) -- ------------------ ----------------------------•-----•----------------------------....-------------------------------•------•---•------------- <br /> ---------------- ------------------------•----------------------------•--------•-••-----------------------------------------•-- •-------------------------------------------•----------------•-- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> --Owner and/or Contractor <br /> By:----------------------------__------------------------------------------------------ ----------------------------•----------------(Title)-- <br /> (Plot plan, showing size of lot, location of sysfem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- f ------------- DATE------ ^� <br /> REVIEWED BY---------------------------- - tt U-------------- ----- ---- <br /> -- - � -�--- - - ---------------� •- -------------------------•------------ DATE----� --1�--u-----------------------....- - <br /> BUILDING PERMIT ISSUED------- ---------------------Illy---------___--- ------------------------_-_- DATE.----- --•------------------------------- <br /> Alterationsand/or recommendations:_--------------------------- --- -- --------- ----------------------- --•----------------•---•-------•------------------------------------------------------ <br /> --------------------1- <br /> ---•------------•-----------------------•------------ --- ------------------------------- ---------------------------------------•--- ------------- ---•--•----•--•--------------•----------------------------- <br /> ---------------•----------------------------------•---------------------- --------------------------------....-. -------------••-••---------------------------------------•-------------------------•------------- <br /> ------------------I--------------------------------------------------------- ----------------------------------------------------------- ---------------------- •-•--------------•---- ------ <br /> FINAL INSPECTION BY:_.__L�_._Sur-tc-_1-- .!- <br /> -------------•---------------- Date.... `_/sz--------------------------------------------------- <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 145446 A-00D 12.54 <br />