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APPLICATION FOR SANITATION PERMIT Permit No. ..... <br /> (Complete in Duplicate) Date Issued --- <br /> Application is 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 49. <br /> JOB ADDRESS AND LOCATION-�' y� Fri; s.1__ _... .! _ - f��1. f `tr Z� --- ------ <br /> 1 /f <br /> Owner's Name___ ' <br /> •� -- --------------------------------------------------------------------------- Phone.................................... <br /> Address_ <br /> >m .. <br /> Contractor's Name. -= "=`' ---- <br /> . ---.--------------------------------------------------------------------------------------------------- ---------------- Phone----------------------------------- <br /> Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _.L_._ Number of bedrooms • '.. Number of baths --L Lot size _-%_-------'f_-------I__._____-_____-- -_________.__ <br /> Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table '1-' _ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe ❑ Hardpan <br /> Previous Application Made: Yes: No New Construction: Yes)] No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND'SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--4 ' .._p__Distance from foundation... 4.r._..__.Material-.. '` !-fit­-­--------------- <br /> 17 <br /> ® No. of compartments.... ------------------S ......Liquid depth......V1----------------Capacity-,n7� 71.4­41- <br /> Disposal <br /> • 1- <br /> p Number of lines---------- -Distance from foundation__�.-.�_'_..-__.Distance to nearest lot line........ <br /> Dis osal Field: Distance from nearest well__ �f .� <br /> ( Length of each line-----1. __ Width of french . . ........................ <br /> / Type of filter material___- __Depth of filter material-.-_.07'. <br /> length....' ------------------------------- <br /> Seepage Pit: Distance to nearest well_4'/'_"._._..__Distance from foundation...�s° '.........Distance to nearest lot line._._S-p__... <br /> 1/� Number of pits-----f---------------Lining material-44.-n/-------- Diameter__-_--3.�_s'_--------Depth.-., $7----___----_.-_____.--- <br /> Ce/spool: Distance from nearest well.................Distance from foundation--------------.-___.Lining material-------_---___--___-_-•.--•._-._-. -. <br /> El Size: Diameter---------------------------------------Depth--------------------- ----•--•---------------------Liquid Capacity gals. . <br /> Privy: Distance from nearest well------------------------------------------------_Distance from nearest building--------_-_--_-_____-_--.,_•-____----__--. <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------•-------•-------- <br /> Remodelingand repairing (describe) ------------------•--------•--------------------•------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------ <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 /> ordinances, State laws, and rules and regulations..of the San Joaquin Local Health District. <br /> (Signed) --3 - __(Owner and/or Contractor) <br /> --- _- <br /> --------- -- -------------- -- --------- -------- -------- ------ <br /> By:--------------------------------------------------------------------------------------------------------------- -------------(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 /> X/ r�. + <br /> APPLICATION ACCEPTED ------------------------------------------------------- <br /> REVIEWED <br /> ----------------------------------------------------REVIEWED BY-------------=---------------------- ----------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------------- --------------------. DATE..------------------------------------------ = <br /> Alterations and/or recommendations-------------------------------------------- - ------------------------------------------------------•--------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------•----------••----•--------•--•-----•-----------••--•---== .......... <br /> ------------------------------------------------------------------------------------------- ------------------------ ---------------------------•-----------------------------------------------------------------.... <br /> ------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- -------- ---•--- ------- <br /> ---------------------------------------------------------------------------- - --- - ---------------------------• ------------------------------------------------------------. <br /> J <br /> FINAL INSPECTION BY;�-- ."_' Y kom'------------------ ------- --------- Date--- ------ J f--------------------------- <br /> ------------------------ <br /> SAN JOAQUIN LOCAL HE ,LTH DISTRICT <br /> 130 South American Street 300 West Oak Street ,I32 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> —2M , Revisea 1.57 FRCO. <br />