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Noo`�-��-----�-----•• <br /> APPLICATION FOR SANITATION PERMIT Permit G <br /> (Complete in Duplicate) Date lssuec�-sr7c-l'--`f�~ ' <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 compli nce,with County Ordinance No. 549. <br /> fid -- <br /> ADDRESS AND CATION__..___!t?�--- _ �- <br /> Owner's Name---------- ---- <br /> Phone----------------------------------- <br /> Address 7� ' ` : c --- ---- <br /> � � � � .��" ------------ ------ •- F _P_ <br /> ----- Phone._ <br /> Contractor's Name------ I <br /> , <br /> Installation will serve: Residence 15 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherElElNumber of living units: _-)-__ Number of bedrooms _ --- Number of baths ___/_-. Lot size .___. > - __ _tl_j____________________... <br /> v1 � <br /> Water Supply: Public system ❑ Community system '❑ Private E§ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand N Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ N <br /> Previous Application Made: Yes ❑ No N New Construction: Yes A 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___`5'0_}----Distance from foundation_____Z_Q-!_____.MateriaL______ ------------------------- <br /> No. of compartments------7)` ----------Size----- _�q �---Liquid depth----------aw------------Capacity-----� 9-------- <br /> Disppoosal Field: Distance from nearest well----A0-`__._.Distance from foundation-__2�______-_Distance to nearest lot line__ ___... <br /> Number of lines----------I-------------- ------Length of-each line--------- --------Width of trench_--"1--oaf ..------------------- °� <br /> ii <br /> '�,,_ 1 DSr ..___De th of filter material_____ _____________Total length-._____APO lerf <br /> Type of filter materia___:___ pi <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------..Distance to nearest lot line____________.____. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h-----------------------------.--- <br /> Cesspool. Distance from nearest well-----------------Distance from foundation_.-----------------.Lining material-------------------------------.------ <br /> ElSize. Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> 4 <br /> _Distance from nearest building %'` <br /> Privy: Distance from nearest well-------- -------------------------- ----- -----------�------- -------------------------------- <br /> ❑ Distance to nearest lot line------ -------- ------------------ ------------------------------------------------ <br /> n �' ^ - � 1 ,�~-�-�-----------------------------------•-•------------ <br /> Remodeling and/or repairing [describe):__"___________f`-�/ 1----- �--�-- ---• ------ <br /> ------I-----------------------------------------------------------------------------------------I---------------------------------------------------------------------­-----------------------------------------------i <br /> ----------------------------------------------------------------------•-----------------------------.---------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquinounty <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_ -------------•- - ----- --------------------------------------------------------------------------------------- <br /> [Owner and/or Contrac#or� <br /> len: betccan be ITi#ie]=:_ --:- ,T _�_a� - ;, __ • <br /> (Plot plan. showing size of lot, location of system in (`elation to wells, buildings, ., placed on reverse sit el. <br /> FOR DEPARTMENT USE ONLY <br /> x APPLICATION ACCEPTED BY------------ LfX­A --------------------------- DATE -�"." <br /> REVIEWEDBY------------------------------------------------------------------------------'------------------------- DATE -:---------------------------- <br /> BUILDINGPERMIT ISSUED-----------------------------------------------------If4---------------------------- ------------ DATE------------------------------------------------------------- <br /> Alterations and/or reccmmendations:------------------------------------- ------ -----------------------------•----------------------------- -- -- ----------------- <br /> - ------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------- <br /> [ ------------ --------------------------------------------------------------- <br /> h <br /> FINAL INSPECTION BY---------------------- Date - . <br /> ►'! W 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 />