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/ l APPLICATION FOR SANITATION PERMIT Permit No. _����. <br /> 3o a , (Complete in Duplicate) <br /> Da 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 ma in "qtfip.*ancrwith County Ordin nce No. 549. <br /> JOB ADDRESS D LOCATIO�d �' Z zoo t � <br /> y <br /> Owner's Name - -' ti _{ " -------- c <br /> _ ------------------ Phone__ a <br /> � <br /> Address-...-.6----- _1t -------- --------------------------------------------- <br /> - <br /> Contractor's Name Phone <br /> ------------------------------------------- - - --------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel tEl •Other, ❑ <br /> Number of living units: j____ Number of bedrooms %3-- Number o aths ._. _ Lot size _—/.O-_ x- <br /> -- <br /> Water Supply: Public system E] Community system [I Pr - Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LClay Loam E] Clay E] Adobe Hardpan E]Previous Application Made: Yes M/No E] ' New Construction: Yesoam No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [No septic tank or cesspool permitted if public ewer is available within 200 feet.) # <br /> Se tic ank: Distance from nearest well_ = __Distance from aund on_ ------____.Materia_ _ __________- <br /> p - Liquid id depth t _ Capacity-/-- <br /> p �! - q pt. =- - <br /> No. of compartments __ Size_ <br /> 10_Width of trench________ -�___�____ <br /> Disposal Field: Distance from nearest well__ZS-- Distance from foundation___�_t,!______-Distance to nearest to liNumber of lines_______J___4 <br /> ______ _.-Length of each line_____ __ <br /> Type of filter materi yp F --- _�CDepth .of filter material------- -_-----•--Total length---------�-0-49----------------- 'S <br /> Seepage Pit: Distance to nearest well_____________________Distance from foundation-------------------.Distance to nearest lot line______.._________ <br /> ❑ Number of pits----------------------Lining material------_----------------Size: Diameter------------------___-_.Depth----------------- - ---------- <br /> Cesspool: Distance from nearest well______________Distance from foundation--------------------Lining material__________:________________-______- !� <br /> ❑ Size: Diameter---------------------- - -------- Depth----------------------------------------------------Liquid Ca ----------•-- 9 4p1 i <br />� ___ als. <br /> Privy: Distance from nearest well------_---------------------------------------------Distance from nearest building____________________.____________-_-_-_-_ a <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------:�If'------------_----•--•--•---- � <br /> RemiDdeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------•--------- <br /> ---------------•--•------ ----------------------------------------------------•------------•-----------------------------------------------------------------------------•----------------------------------------------- <br /> ------------------------------------------ -----------------=------------------------------------------------------------------------- ----------------------------------------------------------------------- <br /> .I hereby certify that I have prepare othis application and that the work will be done in accordance with San Joaqu-pW'County <br /> ordinances, Sta a lairs, and dlIs and.. ulati sof the San Joaquin Local Health District. I <br /> t` Si ned ___________________ _ Owner and/or Contractor <br /> - ------------------------------- t <br /> { / 1 :1 <br /> By------------------------------------------------------------------------------------------------------------------------------------(Title)-----------------------•---------------------------------------- <br /> {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY = --------------------- DATE_'ZZ� ---------------------------------------------- <br /> REVIEWED BY----------------------------- ----------------------------------------------------------------------- DATE--------'2 <br /> ----------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -- ------------------------------------------- DATE` k - - <br /> Alterations and/or recommendations:------------------- ------------------------------------------------------------------------ -------------- <br /> --------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY�z-- = �i `��' ." --------------- Date----- ------ ---- ----------------------------- <br /> SAN <br /> ------------------- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Strew <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9--2M 8-51 Revised W-2100 <br />