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r4r <br /> A <br /> APPLICATION FOR SANITATION PERMIT Permit No. ,1____________ __ <br /> (Complete in Duplicate) S ( i <br /> - Date Issued <br /> MAI <br /> Applica*ion is hereby made to the San Joaquin Local Health District for a p.s it to construct and install the work herein described. <br /> This application is made in compliancewith County Ordinance 549, <br /> J•13 ADDRESS AND L•C •ATI r_— <br /> J � --- -- -- - --- --------- •---------------•-------•---•-•------------------•--------•---- <br /> Owner's Name-------------------------- -, -x.[ --•-•-- ---- ---:-:------=jPhone--------------------_------------ <br /> Address-_------------------- ------------------- -------------------- ------ <br /> Contractor's Name___________ ___ <br /> Installation will serve: Residence Apartment- H e ❑ Commerc ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units. __ ___ Number of bedrooms __lumber of baths __I__ Lot size ------- <br /> ----�—T— <br /> Water Supply: Public system .gi;_Ilr_,�ommunity system ❑ Private ❑. Depth.toNaterjable ."____ ft. <br /> Character of soil to a depth of 3 feet: Sand.E]—'G-ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej__#ardpan ❑ <br /> Previous Application Made: Yes o ❑ New Construction: Yeso❑ <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&,01�istance from foundation----Id_ ..Material.... ,�_ <br /> No. of compartments.......... Size___ ? _ _�.____Liquid depth_._-_- !�_�__-__._Capacity.... -- 7 f <br /> X, <br /> Disposal Field: Distance from nearest weE!_._/ ��-� tance-fro'm foundation..__; Q- ?Distance to nearest lot line- <br /> --Number of lines_______________ .__.___________ Length of each line--._-_�JLQ------------Width of trench_.._.; '�.._ <br /> Type of filter mate6a!___ � _Depth of filter material___. .��___..Total length_______,, ___-'__ _ �__..� <br /> 1 U i <br /> Seepage Pit: Distance to nearest well_-1 /71--e_Distance from foundation______ " __.Distance to nearest lot Irne__-__.--- <br /> .Y� Number of pits---------/----------Lining material--- r.-------Size: Diameter------3­_�_--_.r--Depth-------......2/.0------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------- Lining material_---__._..-.-__._.-___._____.______- <br /> ❑ Size: Diameter---- --- -------- ------------------Depth---•---------------------------- - --------!..I----Liquid Capacity----------------------------gals. <br /> Privy: r Distance from nearest well--------------------------------------------------Distance from nearest building <br /> ❑ Distance to nearest lot fire----------------------------- -------------------•---•---------------- ------------------------- ------------------------------------------- . <br /> Remodeling and/or repairing (describe)__________ -----------------------l7 <br /> -•--•--------------•-----•----•------------••--•----,-------------------••-•--------••--•------- ---------------­---- •------- `----:--- -------------------------••-----------------------.... - <br /> .� J <br /> --------------------------•-----------------------•--•--------------------------------------•---=-------`---------------------•---•-------•----------------------------------------•- •------------------------------------ <br /> I hereby certify that I have prepared this application and`+hat 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 /> r <br /> 1 <br /> (Signed)---- -------- -- ---•-•--------- -------------- ------ ------------ ---- ----- - -----------------(Own /o <br /> By:...... G� - - ----- ------------ ------ --- -„ --.------ ------ � <br /> (Plot plan, showing siz o lot, locati of system in re tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ` - S ----•--•-•--•------•--••---------------- DATE----------- !" 1 ----------------- <br /> ,N <br /> REVIEWED BY .--------------------------------------- DATE---•-----•------------•-----•-----�--�------------ <br /> ---------- ---- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------ -•---------- •--------------------------------- DATE------------...-------------------------------------------- <br /> Altera+jons and/or recommendations:-------------- _- <br /> •-- ! - --- "------ --------- --, <br /> ------ -----•---------------------------------------------------------------------- -------­-----------------­-------------- <br /> ___________________________________ -----------__------_------__________________________ ------------------------------------.....------------ <br /> -----------------.----------- ----------------------------- <br /> --------------___-------------_-----------_-------_---------------------------------______-------------------------------------_---------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.......:.......... --__-: Date... '.._0.V_a.._ ' <br /> -------•-------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Ameriean Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9 145446 n7wpdo <br /> f <br /> _ t� <br />