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APPLICATION FOR SANITATION PERMIT Perm �No. ____----­---_.---_-- <br /> (Complete in Duplicate) ' <br /> Date Issued _ _ <br /> Applica+ion is hereby made„to the San Joaquin Local Health District for a permit to construct and install+work herein described. <br /> This application is made in compliance with County Ordinance No. 549. j <br /> _ JOB ADDRESS AND LOCATION--=--/• ;_t—1 ---- --- - --------- ------------ <br /> Owner's Name--------/: ------- Phone <br /> sAddres7/-- ----- -- ------- f_ <br /> --------- --- - ---------•--- -•--- <br /> Contractor's Name ----- t ---- ------------------------------------' ------------------------------------- Phone- D • ' <br /> Installation will serve: Residence Apartment•House'"❑'-Commercial ❑ Trailer-Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --9 _ Number of bedrooms __ _ Number of baths _ �' Lot:size <br /> - <br /> Water Supply:- Public',systtni-y Community system ❑.- Private ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand.0 Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobejo Hardpan ❑ <br /> Previous Application Made: Yes ❑ No � 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 /> Sep ic,Tank: Distance from nearest well 'Distance from foundation----_----------_____.Material _. _.__._ _,__-_. <br /> I.t No: of compartments___ t ___. --- Size_______ t q p <br /> #Li Liquid de th Capacity <br /> salxField: Distance from nearest well = Distance”from foundation__------------------Distance to nearest lot line.-----r-________ V <br /> Number of lines- -------- -- --Length-of each line-- -- -------------- ----Width of trench--------------------- <br /> 4=7r� <br /> Yp 1 _, �. ;Distance from <br /> materia-----------------------Total length_�__:__________ ________________ <br /> Type of filter material_. '----Depth ofw <br /> Seepage Pit- Distance to nearest wellX rom foundation __�j,Q �, __..Distance to nearest lot brie <br /> Number of pits- ._:_ --------_'__Lining material_ _ _ __ ..Size: Diameter '-__??___--___'_ Depth_____9_S�____________ ___ <br /> Cesspool: Distance"from."nearest well---------.-.__Distance from foundations-"__¢: _:_:Lining material--------------------------------------- N <br /> ❑ Size: Diameter------ -J--=---------------1 ---!Depth-- f -• ---- - - Liquid Capacity gals. <br /> Privy: Distance from nearest well-:-_ _.-':, '---------------.�__z__-Distance from nearest building__=______ .___ ..______. <br /> El __ <br /> Distance to-nearest lot line_ ___ _ __ __ _______ <br /> " _ - - - - <br /> f- .____ ____-_ <br /> ____ __ <br /> Remodeling and/or repairing (describe):-'..--*_ t { 4-- -- -- -----=- ----•------- ----- - <br /> - 1 <br /> ----------------------- ----- ---------- ------------- -----=--- ---- <br /> --------------- --------------------------------------------------- -------------------------------- t-------------- <br /> ------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------............---------- ---------------------=------------------------------------------------------------------- <br /> I hereby certify that 1 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 Joa.quin Local Health District, i = <br /> -41 <br /> (Signed) ----------" .-- ---------------- <br /> By: <br /> _----- <br /> ,y /or Contract <br /> B '--------------u�J--l'-Q�2-Ltd --------- --- ----- rand -I-V-------------- <br /> (Plot <br /> wne or) <br /> y ----•(Title ---- --- ------- - '----- <br /> plan, showing size of lot, location of 8�stem in relation to wells, buildings,,etc., can be placed'-on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE-;V- <br /> --- -------- -------- ------- ----- - <br /> REVIEWED BY-------------------------------- <br /> -- -- - --- ------=------- -•----- ----- -------------------------- DATE----- <br /> BUILDING-PERMIT ISSUED ------------- •---------- DATE---- --------�------------- <br /> Iteratio�is and/or recommendations l .i r <br /> F s <br /> r f r� s t s <br /> ,* ---------•--••-------------------------------------- <br /> --_ ---------------------------------� --- --- -------- <br /> --- t..........----------------­---4 ' _s + <br /> - -------- •-------- /fes Cy <br /> FINAL INSPECTION-BY:-- :--------------�J--. --- --------- <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 /> r <br /> ES-9-2M Revised W-2100�' " '` ' "" `�" tt4i��"+�..L� t ..,...,c <br />