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Y\e <br /> APPLICATION FOR SANITATION PERMIT Permit No. �'0.- - •--- <br /> (Complete in Duplicate) Date Issuedk i <br />;b Applicafion 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., x <br /> JOB ADDRESS AN LO ATS®I Z 5 ---------------------------- ---------------------- <br /> - �, <br /> Phone-------- --- ----- <br /> J, <br /> --- Q <br /> Owners Name # <br /> �, _ F =- --- /------------------------------- <br /> Contractor's <br /> ---------------------- <br /> Address--------• -- -- -------��--- -----•-----------------•------ <br /> ------ ----- ------------- -- - <br /> Contractor's Name---- -------------- ------------------------------------------------------------ <br /> Phone-------------------- ------------ <br /> Installation will serve: ResidenceVApartment House ❑ Commercial [ITrailer Court Motel Other <br /> r /� i <br /> 77 Gy )f -------------------------------- <br /> Number of living units: _ --I_ Number of bedrooms ._�iA_ Number of baths_-_. Lot size ___________-----______ __ <br /> Water Supply: Public system Community system '❑ Private ❑ -Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ElSandy Loam , Clay Loam E] Clay El Adobe �ardpan ❑ <br /> Previous Application Made: Yes El No New Construction: -Yes o ❑ W <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feetr) #r� <br /> SepticeTank: Distance from nearest well__---�'______Distan e from ddfoxunion___________________Ma1tri�l_________ Q-- <br /> No. of compartments------------- --------Size_ __ C�-- - -?'---Liquid depth------- _-------------Capacity-----La- -Q----- <br /> Disposal Field: Distance from nearest well------------------ from foundation_--�------Distance to nearest lot line----------------- <br /> i <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench------_---------------------------- <br /> ❑ Type of filter material-------------------------Depth of filter material-----------------------Total length_____________---______-_______--________-_ . <br /> Seepage Pit: Distance to nearest well---------------------- <br /> 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-------------------- material------------------------------------- <br /> ❑� Size: Diameter-------------- ----------------------Depth-----------------------------------------------------Liquid Capacity g <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____---_____________---__________.__,___. <br /> Distance to nearest lot line---------- ----------- --------------------------- <br /> Remodeling and/or repairing [dcscribe):-------------------------------------------------------------------------------------------- <br /> --------------------- <br />" <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------- <br /> }: <br /> ------------ - - -- - --------- -------- ----------------------------------------------------------------------------------------------------------------------------•-------------------- <br /> I 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 Contract <br /> ----------- ------ <br /> BY----------------------------------------------------- --- ---------------(Tiflei------------------ ------- <br /> --- - ---------------------------------------------- --- -- <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------------------------ ----------s ----•--- ------------ -------- ------------- -------------- -------. DA ------ <br /> ------------------•------- <br /> n ©ATEA �� n <br /> BUILDING PERMIT ISSUED------------------ --- -- <br /> Alterat ns and/or recQ men atio s:__ ____.. `1Q, /(iJ <br /> _ , <br /> 1 � ►fit.- _ ---------------------------------�------------------- ------------------ ------------------------------I------------------- <br /> ------------------------------------------------------------------•---- ---------------- --------------------- -------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY: \ v Date----------- ----- ------------------------------------------------ <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California <br /> LoJi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />