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APPLICATION FOR SANITATION PERMIT Permit No. .,. -a..!1�__ <br /> (Complete in Duplicate) <br /> Date Issued 1�' <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. 549. 447 <br /> JOB ADDRESS AND LOCATION..._�_�___�__,�^�----- jel---)----1---------1�ll�S�------- <br /> -----------;� ------ �-----=�-t�--- - - -- - ------ <br /> Owner's Name--------------------- � �� - - <br /> ----- <br /> Address -- -- ---- Phone------------------------------------ <br /> p/ - d ----------------------- <br /> /!�`� y#� <br /> Contractor's Name------------- -----------------------------------•-------------------------------------------------------- <br /> ----------------------------------- Phone---------------------------------- <br /> Installation will serve: Residence �j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __!___ Number of bedrooms J____ Number of baths __/___ Lot size _____�t_________________________-___ <br /> Water Supply: Public system ❑ Community system fl Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand KI Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ 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 /> a O� <br /> Septic Tank: Distance from nearest well_ ??O __-_-'l3istanc afro oundation_________ <br /> 1D--------.Maferial----��- � --------- <br /> No. of compartments------------------�---Size_��_ )(-�-----Liquid depth----- ---------------Capacity--- <br /> -Disposal Field:Field: Distance from nearest.well_41010_-t'Distance from foundation---ZO_� -_--Distance to nearest lot line�_fJ�.______ <br /> Number of lines-_____-_-_-0�-f..___LL_____Length of each line________Q_ ��____Width of french___/__ __--_- <br /> Type of filter material__S_�f k___-Depth of filter material_____-1 __ -___-Total length_____-_-�_0------------------------ <br /> Seepage Pit: Distance to nearest we}I----------------------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 foundatior--------------------Lining material_______-_____________-__----_--«_____. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot kne-------------- --ff----1- - -J-- ---------- - ��------- ---------------------- -------- <br /> -�--� ---------------- --------------- ---Remodeling and/or repair•ng (describe): am______________ - a�---�' <br /> ---- `�''�-� <br /> ---------------------------------------------------- --------------------------------------------------- <br /> ----------- ----------••------___ __----___/__ "---IJ'-' - ------------------------------------------------------------___-----------------------------------------------------_------------------- <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 Contractor) <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)------------- ------------------------------------------------ <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -- --- - - - DATE ^- <br /> REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE--- ------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------- ------------------------------------------------------------------- DATE----------------------------------------------------------- <br /> Alterationsand/or recommendations:------------------------------ --- ----------------------------------------------------------------• ---------------------------------------------------------- <br /> ---------------------•---------------------------------------------------------------------------•--------------------------------------------------------------I------------------------------------------------------- <br /> ------•--------------------------------------------------------------------------- ----------------- -------------------------------------------------------------------------­-------------------------------------------- <br /> -------------------------------------------------------------- <br /> -------------------- --------------------------------------------------------------------------------- <br /> .../ <br /> FINAL INSPECTION BY----------------- - -------------------------- <br /> ----------------------- Date---------------A2------•A -------------------- <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 /> ES-9-2M 8-51 Revised W-2100 <br />