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APPLICATION FOR SANITATION PERMIT Permit No. --(t1__. �f <br /> \ (Complete in Duplicate) <br /> rl Date Issued!_Q_-,_l-_-____-___ <br /> Applicakion 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 No. 549, <br /> JOB ADDRESS ANDEL CATIO ---._�/ __ <br /> ------------- ------ -----••------•------------•---------•----..... <br /> Owner's Name------- Wit` ------------------ -------------------------------------------- Phone----- ,�•�a�E -_ <br /> Address,'­?-_C-�_ --- -----------------------------------------------------------------------------------------------------------------•- <br /> Contractor's Name------_---- 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 _/___ Lot size ___�����-�____________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table,0_ _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe-Ar Hardpan [❑ ` <br /> Previous Application Made: Yes ❑ NOX New Construction: Ye� No ❑ Q <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- <br /> No. <br /> _-.___-__ _______________________________No. of compartments----------1-r- -----______Size--------------------------------Liquid depth.------------------- Capacity <br /> Disposal Fi d: 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 it: Distance to nearest well-,--.- �_____Distance(fT fo dation__,1-....___.Distance to nearest lot line_____Number of pits.---/---------------Lining material C _ __..5ize: [}iameter--- e •�-------Depth------ --- ------ " <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_----_____--.-----_________-______. <br /> ❑ Size: Diameter--------------------------------------Depth'---------------------------------------------------.Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--_.---_______________________________________Distance from nearest building---------.---------------.--------.-___._. <br /> ❑ Distance to nearest lot line------------------ ----------- ------------------ <br /> Remo ling and/or repairi g.(describe}:---_ r ____ r , 11� �___ __ _. --- <br /> 11-1Z <br /> -------•--------------------------------------,77 - <br /> f�_._.�_ �. f-�7', - -------------------------------------------------•-----.-...-------------------------------------------------------------•--------•-------------------------------- <br /> �,f ' -- <br /> I hereby c?rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, WStaws, d r Iles and re ulations of the San Joaquin Local Health District. <br /> (Signed)------- :�___ _... :. = --------------------(Ower /ar Contractor) <br /> By:... -:----------- -------------------------------------------------------------------•-- {r+I - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be ed an revers8, e). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -----_----------- -----------------------------------------•------------------------ DATI�---- <br /> REVIEWEDBY--------------------------------- -- --- ---------------------------------------•------------------------------------•- DATE--&---------•----------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------43- <br /> Alterations and/or recommendations--------------- <br /> ------------------------------------------------------------•--------------------------------------------------------------------------------•----•--------------------------------------------------------------------------- <br /> ------------------•------------------------------------------------------------------------------------------------------•--••--------------------------------..------------------------------------------------------------ <br /> ---------- ------------------------ ----------------------------------- ----------------------------------------------------- --------------- <br /> �, --------- .�------------- <br /> FINAL INSPECTION BY------------ ---- ---- -- '- - - - -- ---------- -------- - ----------- --------------------------•--• <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 ; IRevised W-2400 <br />