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q <br /> APPLICATION FOR SANITATION PERMIT Permit No. . •-•G <br /> {Complete in Duplicated Date Issued <br /> Apple afion 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. le <br /> 14to- q_,q----pie , <br /> JOB ADDRESS AND LOCATION------------------17-7f-------------4�X.-- d)j- -- <br /> t/e/ --------------------------- -------------- Phone----------------------------------- <br /> Owner's Name-----------•---------------•-------u"t�-1`t���-----�--------- --+`�•--------'------- -- <br /> Address--------------- ------------------------------------------------------ <br /> 1` --------------- <br /> I ------- Phone---------------------------------- <br /> ----------------------- <br /> Contractor's Name--------•---------•------------------------•------------------ - , <br /> Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Insta{lation will serve: Residence, Apartment 1-louse ❑ ❑ <br /> Number of baths ----I - Lot size --------�- ---------------l-Tr=----------- <br /> Number of living units: _.____._ Number of bedrooms __� , <br /> Water Supply: Public system ❑ Community system ❑ Privateo Depth to Water Table Clay E3 <br /> Adobe Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel,❑ Sandy Loam' ClayLoam ❑ ❑ P ❑ <br /> Previous Application Made: Yes ❑ NorV1 New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> • .Material-ii --- --------- -----� <br /> Septic Tank: Distance from nearest well___--.�----- <br /> Distance from foundation- _-X----- . <br /> Ca acit � - <br /> No. of compartments z----------Size------ Liquid depth- �. p Y r <br /> ------Distance to nearest lot line....-,S--•-- <br /> Disposal Field: Distance from nearest well------ 4-----Distance from foundation------ -- <br /> Number of lines------------- ---i---------------Length of each line-----D.-AX:SS '__.Widfh of trench_...-._y____�----•------ <br /> 7ype of filter material------ Yk.............Depth of filter mater <br /> Seepage <br /> ----.------Total length-----------f_ ------------------ <br /> JIN <br /> Pit: Distance to nearest well---------------------- 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 /> ❑ els. <br /> Size: Diameter------------ ---------- ---------- Depth_ --------- -------------------------------- <br /> ------Liquid Capacity- -------------------------g <br /> Privy: <br /> Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------------- <br /> Distance to nearest lot line--------------------------------- ----------------- <br /> ----------------------- <br /> Remodeling and/or repairing (describe):----------------------- ----•----- ---- <br /> /ltsty-. C '----------- - --------- <br /> ----------- <br /> -------------------------------- ----------•-------•-- ------------- -------------------------------------------------------------•---------------------------------------------•----------- -------- -- <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinancAStelaws, and rules nd regulations of the San Joaquin Local Health District. <br /> -------------------------------------------(Owner and/or Contractor) <br /> (Signed). <br /> - ------- ------- <br /> 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--------------------------- <br /> REVIEWED BY------------------------------------------------------------------ ---------- <br /> l�' ' <br /> DATE---- ---- -------•-------•-- <br /> ------ -------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------ -------- -------------------------------------- ----- D <br /> Alterations and/or r oATE <br /> mmen of ns•-- -- ------------------------------------------.----- _ --------- - -- <br /> r <br /> a i <br /> ----------------------- <br /> ------------------------------V_ .­-------­...... --------------------------------- <br /> ---------------------------- <br /> _____ ___ __________ _ ____ <br /> ----------------------------------------------------- <br /> ____. __---.__-- --.-_--- ----------------__..___.___._ <br /> o` r , -------------------------------- <br /> FINAL INSPECTION BY---------- ------------------- <br /> Date <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street in Sycamore Street 814 North "C" Street <br /> 130 South American Street Trac California <br /> Stockton, California Lodi, California Manteca, California y <br /> ES-9-2M 10-52 Revised W-2100 <br />