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l <br /> APPLICA"ON R)R SANITATION PERMIT Permit No. ....G?.. ..��... <br /> (Complete in Duplicate) 6/ <br /> Date Issued .......l�S..... <br /> Applica+ion is hereby made to tha San Joaquin Loc;1 Health District for a permit to construct end install the work herein described. <br /> This application is made in compliaice;with County Ord�ance No. 549. <br /> JOB ADDRESS AND LCC(JION.......:.......S...U.........�.�!a.:u..T.� �.....!/�!�:.. -.......................................................... <br /> Owner's Name Name.................... % , ..........f..t.... ......... r............. . ` ...... <br /> .. Phone......................................................... _... <br /> Address.............. ......................................................................................................---.......................---......................................-----................ <br /> Contractor's Name.............................7.......... .. ....,........-----..................................................................... Phone................................... <br /> Installation will serve: Residence�Apartment House ❑ Commercial ❑ Trailer Court [_J Motel ❑ Other ❑'6�, <br /> Number of living units: .../.. Nomber of bedrooms 4^.,Number of baths ./-- Lot s;�e ....... .................. <br /> Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table ..it. <br /> Character of soil to a depth of 3 feet: Sand❑ Grovel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe Hardpan❑ <br /> Previous. Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND «ECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well..:5-0.......Distance from foundation..��.........Material..... !. <br /> (� No. of coma:artments......_.7..:.........Size---�1..Y-.�� -s:-----Liquid depth.......... ./.4...'...Capacity............... <br /> Disposal Field: Distance from nearest well. .-`-CJ.,.Distance from foundation....... ..Distance to nearest to <br /> Number of lines........ !...Length of each line........'r.�...7,�,.r:.....Width of trench................. <br /> Type or filter material.... 2 <br /> �-�..�"�:.�--Depth of filter material.......� ..........Total length............. 0 <br /> .................... <br /> Seepage Pit: Distance to dearest well ....................Distance fromfoundat:on....................Distance to nearest lot line................. <br /> ❑ Number of pits......................Lining material.......................Size: Diameter.......................Depth................................. <br /> Cesspool: Distance from nearest well.................Distance from foundation...................Lininy material..................................... 0 <br /> ❑ Size: Diameter..... ... .. . ...... ...... .......Depth...................................................Liquid Capacity............................gals. <br /> Privy: Distance from nearc,t well.................................................Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line......... ...........................�...........................................................................�..t..,......................... <br /> Remodeling and/or repairinc (describe):....... G �."�`• •L` .••: <br /> o ( . tr ••••••�;. !.:.......... <br /> .... <br /> .... G <br /> ..-...................... .. ........ . .......................................... ....................... .... <br /> . .... _ ....... ........ <br /> ...r... t.y.�.. —�,. ..........a —/4'r:... ll�.. <br /> . i ... ....................l� .. <br /> I hereby c Ify that I have preparr;d this application d that the work will Cfe don(�in accordance with Sen Joaquin C ty <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)..................................... ................................................ ... ....................... ........................................(Owner and/or Contract <br /> or <br /> ............, , r ............................................................. <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 /> ^PPLICATION ACCEPTED BY.. ;� -_ ....................... .... DATE......_. ,r\fr ...�.... <br /> U ,-1 DATE................./....('' <br /> REVIEWED BY.............................. U ... ......................... ....... ...................... <br /> . .................. .... .... ........ <br /> BUILDINGPERMIT ISSUED............. . . ......................................................... ......... DAIE.............................................. .............. <br /> .,_ <br /> Alterationsand/or recommendations:::.................. ... . ....... ...................................................................................................................... <br /> _.. ..... ........'.... <br /> ; rr _... <br /> ....... . <br /> _._. <br /> ............. ... h .. ... ...... <br /> .......................... L ,,r l` ,................... .... ................................. <br /> . .. ... .... ..................... <br /> FINAL INSPECTION BY:._..!.. L..✓......_.. _...._. De+e.... . .... :........:.. ............. <br /> / <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West 0e1, Street 132 Sycamore Street 814 North •'C•• Street <br /> Siockton, Celitornia Lodi, Callo•nia Manfeca, CaMornia Tracy, Celitornia <br />