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APPLICATION FOR SANITATION PERMIT Permit No. ...Q..J�..:z........ <br /> •�' (Complete in Duplicate) <br /> Date Issued ......... ............ <br /> Application is hereby l{made to the San Joaquin Local Health District for'a permit to construct and install the work herein described. <br /> This application i made in compli• nce,with County Ordinance.NM of X49. <br /> L� <br /> JOS ADDRESS AND LOCATION... .....Z......:...... ._._.... �e ..- D '" - -..... <br /> 1, r` <br /> Owner's Name. ..... ..... .. ••. ^�� ..... Phone.f 4../�.". t,77,5+1 . <br /> = ........ <br /> Address............... r . 1 �1....... <br /> ... .._��.._..___..-•---....._..__........__---......_._............_.._...-------••--•----..----........._.... ........................ <br /> Contractor's Name----........_ ---- .......... ....... ....................................... <br /> ...._.._... Phone, ...`1' �. ... <br /> Installation will serve: • Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._ Number of bedrooms ..off Number of baths ../.-.',Lot size ......_1�.......G'_L-.......".:....................... <br /> Water Supply:, Pubiic sysfem40 Community system ❑ 'Private Depth to Water Table ._E'/..4 ft:" <br /> Character of soii'fo a±depfh;of 3 feet:' Sand [j Gravel L]. Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 2-*"rNew Construction: Yes ❑ No ©- SNA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or c'ess�ool permitted if public.sewer is available within 204 feet.) , T <br /> t' Task: Distance from nearest well...............'_.Distance from foundation.....................Material........................................_,....... <br /> No. of compartments........................tSize------------._..................Liquid depth................----------Capacity............. ... ..... <br /> .Distance from foundation...- 5-._..Distance to nearest lot line. �5..�_ <br /> I • <br /> Disposal Meld: Number Distance of I nesearest we111�� �t. _.__.. Length of each line___. .._a S _.........Width of trench._t_._!Z.y ................ <br /> Type of filter'rnaterii+l-._.`Zi_: _!�__Depth'of filter material..._._,1:$.'�_....Totel iengfh.......atm......................... <br /> Seepag ' ifi: `Distance to nearest well:.; Q:Q_ ,__._Distarice front'fou da+ions-!'..'S�..__:gislan�o to nearest lot lina....�5 .�. <br /> 01 <br /> Number of pit s...... .............Lining material.._ t--Size: Diameter.-_..,Z.-_�_.._........Depth......R s=.r__....._.._.__. <br /> Cesspool:' Distanca from nearest well.................Distance from foundation.....................Lining material.........................:.... ...... <br /> Size: Diameter--------------------------.--------'_Deptli....................,...............................Liquid Capacity................... '....gals. <br /> Privy: Disfanco from nearest well...:...............:.:.::.:.................:....Distance from.nearest building.......................... . <br /> •- --Distance to'nearest lot .........- '- <br /> Remodeling and/or <br /> repairing describe <br /> 9 / P 9 I )' _....---••- ................................................... <br /> .... ......... ••-•-- -••-----...------•----•---- <br /> ..._ ...-------•---•---••----.••-•--............................................................_. <br /> ................ : ....................................................... •-----.....•-•-----•--•-•--....._........ •--......_......... ............._......-----._.__............__ <br /> t <br /> I hereby certify-that l have-prepared this epplicafion and thaf the work will be-done in accordance with San Joaquin Countyl� <br /> ordinances, tate s, and rul s and regulations of the San Joaquin Local Health District. <' <br /> . . <br /> (Signed).......... ................................._..........`.._........_.__....... ................,... : .............I.....:.._................ ---- r and/or Contractor) <br /> t.x/ {Title) ` ,� <br /> ne <br /> I <br /> BY:................:..:.................... . <br /> (Plot.plan, showing size of lot, loco ion of system in relation to Is, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY................ ..r,;,..;. . . . ._.............................. DATE. 4.. , _..........._.......... ................. <br /> REVIEWED BY...........::..... 'DATE........... _.�� .................... <br /> BUILDING PERMIT ISSUED.........................,........ ._�........................._..............DATE...........~ ..................! <br /> Alterations and/or recommendations.................. ---... ... .. <br /> l ............................................. •••--......................................................................_......................................................................................_....... <br /> ..........................................:...........................:.................................................................................................................................................. . <br /> .........................................................................................................•-........................................-•-_....._.......__.............•................_.............. <br /> ,.... <br /> Date...........ra <br />