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1 APPLICATION FOR SANITATION PERMIT Permit No <br /> — �� (Complete in Duplicate) <br /> Date 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 made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND AT . N6 ---------— <br /> Owner's Name--------- = F + e .2.Z—0 <br /> ---------- ---------- - Phon ------------------------------------ <br /> ---- ---- ----- ----- --------------------- ----------------------------------------------------------------------------- <br /> Contractor's Name -•--------------------------------- -------•--•------------------------- ------- Phone----------------------------------- <br /> Installation will serve: -Residencepartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms _2'�____ Number of baths .-8---- Lot size <br /> Water Supply. Public system_5j--C-ommunity system ❑ Private ❑ Depth to Water Table ________ ft_' <br /> Character of sail to a depth of 3 feet: Sand [I Gravel E] Sandy Loam E] Clay Loam ❑I Clay E] Adobe ardpan E]Previous Application Made: Yes E] No New Construction': Yes �o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: w TM <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r <br /> Septic Tank: Distance from nearest well Distanncce from foundation---J42________-1Material-/ <br /> .�" . <br /> No. of compartments_.. :"_____________Size____. _.- } _�_-,Liquid depth__-T__/ _-____--Capacity_____1 Q - <br /> p Distance to nearest lot Iine__1b_._..__. <br /> Disposal Field: Distance from nearest well��__-_.._.Distance from foundation__ _______________ <br /> Number of lines_„3_____ __________1_ Length of each line__3A'.2A_"�-,Width of trench--------------- -- <br /> Type of filter material__�L I-----Depth of filter material___ ------------- length__./">i4__--_____--___ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation______•.___-___-_-.Distance to nearest lot line__.__________.._ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Dia_meter------------------------Depth--------------------------- <br /> ------ <br /> Cesspool: Distance from nearest well----------------- from foundation-------------------.Lining material_-_-_-_____________--__.____ <br /> ❑ Size: Diameter----------------------- --------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well __._-_„___,------------------------------------Distance from nearest building------.______________-------------------. <br /> -------------------------------------------------------------------------------------------- <br /> ❑ Distance to nearest lot line________________._. <br /> Remodelingand/or repairing (describe):------------------------------------ ---------------:-------•-----•----------- -------------• --•----------------------------------------------------- <br /> -------------------------------•------------------•-•--------• ------•---•------------------------------------------------------------------------------------------------------•------------------------------- <br /> ------------------------------- -------------------•-------------••-----------•--------•---------------------------------------•----------------------•-------------------------•------------ --------------------- ...... <br /> 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 /> (Signed)------------------------------------------------------------------------------------------------------------------------------------------------- ------.(Owner and/or Contractor) <br /> ? -----------------(Title)- ------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ <br /> -------- --- ------------------------ --------•------------------- DATE---- ---- <br /> REVIEWED BY DATEr = ------------- <br /> BUILDINGPERMIT ISSUED-------- ------------------ ------ --------------------------------------- ----------------------- DATE <br /> Alterations and/or recommendations:-------------------------- --- ---------------------------------------------------------------------------------•----------------- <br /> ------------------- <br /> ------------------------------------------------­-------- ------ ------•-------------------- -----------------------------------------------------:---------------------------------------------------------------------- <br /> ------------------ <br /> ------------------------------------------------------------------------------------------L-------------------------------------- <br /> iI <br /> FINAL INSPECTION BY:.. Date ! � <br /> ---moi-'--- <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 R0-52 Revised W-2100 . <br />