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� <br /> APPLICATION FOR SANITATION PERMIT Permit No. _._ _-� <br /> (Complete in Duplicate) Date Issued <br /> l� <br /> Application 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. 544. <br /> JOB ADDRESS AND LOCATIO -- ,9/J�-- ----------------------------------------------------------------------------- <br /> ` •�:. <br /> -------------- Phone--------"`--=----------------- <br /> Owner's Name------Address-------------•-�7_ -----------------------------------------------------�' ------------------- <br /> Contractor's Name--------�----------- 1t4e-�J------------------------------------------------------------------------------------------- Phone_� -------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other, 3T-J <br /> Number of living units: I--_- Number of bedrooms -------- Number of baths -------- Lot size -------- --------------------- <br /> Water Supply: Public system ❑ Community system fl Private X Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe D§ 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 /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------- <br /> ❑ No. of compartments-------------------- ----Size-------•------------------------Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--------------_- <br /> F1 Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h_----------I----------------------- <br /> Cesspool: Distance from nearest well_-- Q�-__Distance from foundation------�D-_f_.Lining material..... .L7-.. <br /> CKSize: Diameter------�--X-fo-----------------Depth-----------J-a---------------------- ------Liquid Capacity-- �. � gals. <br /> Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building---- --___-------_------__ <br /> ❑ Distance to nearest lot line------------ -------------------- --------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-------- C - " -------- =-------- ----- -------------•--- <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 /> (� � �•, - <br /> -----------------------------------------------------------------(Owner and/or Contractor) <br /> -------- <br /> ---------- ---- Title <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 13Y �--�l.=r ----- DATE ---• p� <br /> REVIEWEDBY---------------------------- (/ ---------------------------------- - DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------- -- - ----------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations----------------- -------------------- - ---------- ---------------------------------------------------------------------------------------------------------- <br /> - <br /> ------------------------------------------------------------------------- 14 i7C �-------- <br /> I <br /> - - <br /> ------- - - -------- -------Iy / - .0 S <br /> zoo <br /> --- S - - ---------------------------- <br /> ---------------------------------- ------------------------------------------------------------------ -- ----------------- <br /> ! DateFENAL INSPECTION BY: Y, - ----------------------------- <br /> SAN <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 /> E5-4-2M 8-51 Revised W-2100 <br />