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�f Permit No. ..--- ----- ---•-•-- <br /> [ APPLICATION FOR SANITATION PERMIT . <br /> 1 S <br /> a t �- (Complete in Duplicate) f <br /> ,- Date Issued I-- - <br /> Applica-'ion 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 /> ------------------ <br /> JOB ADDRESS AND L CATION--------- --------- ; <br /> ` PhoneA-J----- <br /> Owner's Name-_------ --- -------- ----- �' - --------- _---------•--•-- ----------------- ----- �. <br /> ------ -----------------------------------•------------ ----------------------•------•[-------p----�--------•----- <br /> Contractor's Name--------________°__ , <br /> -� .- ------------------------------------- Phone _Q- f- �, <br /> Installation will serve: :Residence []Apartment House F] Commercial <br /> ❑ Trailer Court ❑ Moel [I Other El <br /> -___--- ' <br /> Number of living units: ___I_-- Number of bedrooms -,4— Lot`size -Number of baths _� �- Oto1. - <br /> Water Supply: 'Public.system' Community system [I Private ❑ Depth to Water Tabled-- ft: <br /> Character of soil to a depth"of 3 feet: Sand E] Gravel ElSandy Loam [1) Clay Loam [IClay ❑ Adobe.[�Nardpan ❑ <br /> Previous Application Made: Yes ElNo ❑ New Construction: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within . feet. <br /> - Material----------=----=---------------------------- ---- <br /> Septic Tank: Distance from nearest wel _ ____ _.___Distance from foundation_____ _________ __ Capacity------------------------- <br /> F ❑ No. of compartments--------------------------Size--------------------------------Liquid depth- ^------- , <br /> gp;l <br /> I. : <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 /> Type <br /> __-._---------------------------------- <br /> Seep 9 LL-_...._.__.Distance to nearest lot li?e-._______________ <br /> Number' to nearest well._44-0________Distance from fou dation_____: <br /> See a e it: Distance / (t C Size: Diarrieter_.__-s.. r -��----Depth__a----------------------- <br /> of pits-------- material____,. <br /> Cesspool: Distance from nearest well_________________Distance from foundation__._______.____-_Lining material_____..____._____.---- gals. <br /> ❑ -Liquid Capacity--------------------------- <br /> - Size: Diameter--------=--------------- -Depth = g <br /> i :l <br /> Privy: Distance from nearest well----------------------------------------------- Distance from nearest building------------------------------------- <br /> Privy: <br /> Distance-to nearest;lot;line."' ----- -•-----------------"------------------------------------- <br /> Remodeling and/or repairing (describe)---------------------------------------- ---------------- <br /> ' = <br /> ------•----------------- <br /> ..-----••_------------------------- <br /> k - <br /> pl ____________________________ <br /> --------------------------------------------------------- _______________________________________________--------------------------_-----------_----------------_---------- <br /> _ _ <br /> I hereby certify that 1-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 /> • ---------------------------------------- - -(�rrrer and/or Contractor) <br /> (Signed)------••----•- <br /> ----- -- <br /> By---------------- - ------ ------------------------------------------------------------- .....(Titl )---------------------------•-------------------- -------------- <br /> e <br /> (Plot plan, showing size of,,aot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ----------------- <br /> APPLICATION ACCEPTED BY------------------- ------- DATE 3/-Z� .f� <br /> ;i DATE-- �-- --------- ----------------------•---------�-•------- <br /> REVIE BUILDE _ _PERMIT ISSUE' -------------------------------------------------------- ---- <br /> D--------------------- ------------------------------ DATE. <br /> -----------------------------•-----------------•----------- <br /> Alterations and/or recommenda+ions------------------------------------------------ ------ <br /> . _____________________________________________________ <br /> ---------------------------________________________________ <br /> -----------------------------•- --------------•­---------------------------------------------- <br /> ` --=------�---------------------=-----------•------- <br /> FINAL INSPECTION-BY! :_._-_.-.---------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West oak Street 132 Sycamore Street 814 North "C' Street <br /> 130 South American Street 01 <br /> TracCalifornia <br /> Stockton, California Lodi, California Manteca, California y� <br /> ES--9-2M : Revised W-2100 <br />