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` 3 APPLICATION FOR SANITATION PERMIT Permit No: :: ..�� <br /> i in Duplicate) <br /> (Complete P� ) Date Issued -------- ��S~�. <br /> t A,plication 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 /> JOS ADDRESS A L ��A�TION - Q.. _.... . -------- <br /> • ........................................... <br /> .t'➢" L <br /> Owners Name... .....-•...... Phone <br /> Address_-..._/-�._ •Q__.. ... -----•--------------------------------•----•--- -•---------•------• --- <br /> -- ... <br /> t� / <br /> Contractor's Name........... 1 ...•.......�. r............... Phone 7.�_ _H-Z. ... <br /> y Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ./... Number of bedrooms..' '_ Number of baths _-/__ Lot size .... .`...X.._ .a d.�............... <br /> Water Supply: Public system ❑ Community system ❑ Private j• Depth to Water Table Y.4. ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F] Sandy Loam E] Clay Loam [3 Clay E] Adobe, Hardpan ❑ 91 <br /> Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ Nox � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> � 'Se enk: Distance from nearest well.................Distance from foundation....................Material..__........._..__.........__.............._.__. <br /> No. of compartments........... ......._----Size--...........................--.Liquid depth---------••--'............Capacity------------_----•---` 1 <br /> S - 3_e_____.Distance to nearest lot line..._3�..._ <br /> Disposal Field: Distance from nearesfi well....S____... Distance from foundation_-__._- <br /> Number of lines.............../__...... Length of each line---____6----- ...__--.Width of trench....... --5�........_.......... <br /> Type or filter material...,Si_ _...Depth of filter material......1.'.........Total length........r!_ ...................... <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 /> CISiz,4: Diameter....................................Depth..............................•..........:__:.....Liquid Capacity-_-•--------••--------....gals. Ai <br /> Privy: Distance from nearest well..............................................I Distance from nearesf building............-__.--.-------_--------_--. <br /> ❑ Distance to nearest lot line--------------• -_----- ---..... - ----------...................•,...------------.....-••••-.......----•-....... <br /> Remodeling and/or repairing (describe):....._•• .--�...916.0-11?................................. <br /> ---••----------------------------------------••--•--------------....._......-•---...---------------•--. ......---•--.......-----••----•--•--- .......... <br /> ......................- <br /> I <br /> I <br /> I hereby certify that I have prepared this applicatiori'and that the work will be done in accordance with San Joaquin County <br /> i <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> f . •---•--•----.......... and/or Contractor) <br /> t (Signed) <br /> ........... <br /> BY: t — —= ...�cf <br /> ` `'s"'„ ---------------------------------- -.(Title} <br /> (Plot plan, showing size of lot, tion system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY p <br /> APPLICATION ACCEPTED BY - - � -�1AT. . :.......... ----------- DATE.......L_" '. - <br /> REVIEWEDBY-------------•-----------•• ...... .. ---------............----------- DATE---.--_..-----.---.--••-----------------------------•--•-... <br /> BUILDING PERMIT ISSUED---------------_-----...................................•••......-•--•............................. <br /> DATE.......................------------------------------------- <br /> Alterations and/or recommendations:••-••- •-----------••......................•-•---------•------------•----••-----......................................... <br /> ..............................................................................................................................................-•-------•---•-•-.:•--......................................................... <br /> ----------------------------•----...................................................................... ................................................ <br /> .........................•----•---••--------..•..................._...-----...----.............. ................ <br /> .----••-----•--•................•------•-•--•-•-._...---•----•-••--------••-•-•--•-•...... <br /> FINAL INSPECTION BY:.........I .................. Date.... .. , � .. <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 /> t� ES-9-2M 10.52 Revised W-2100 _ <br />