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R1� <br /> APPLICATION FOR SANITATION PERMIT Permit No. _ W—V- --------- <br /> L ' (Complete in Duplicate) t-- <br /> �f --��• t Date Issued ----- -- --•------ <br /> Applicaa-ion is hereby made to the San Joaquin Local Health District for a permit to construct a d install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS C TI N_ <br /> .Gam--- -- - -- - -- - <br /> Owner's Name-(----- ------- ; .. . ------ - --------- - -- -- ----------------- Phone------- Z-7 j9! _ <br /> Address- — ---- -- -- --- <br /> Contractor's Name----------------•-- ---- -- ---- v -------------------------------------------- --•------------------ ---------------- Phone---------- ------------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot I ❑ Other ❑ <br /> Number of living units: __/--- Number of bedrooms .�__ Number of baths __�--- Lot size�y,/�__�-'_______________________________ <br /> Water Supply: Public system ❑ Community system ❑ Privateg Depth to Water Table_,�Q ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeHardpan [❑ <br /> Previous Application Made: Yes E] No� New Construction: Yes No ❑ \� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> `` �� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sep Tank: Distance from nearest well---- --Z- ---Distanf q from foundation_--V.- Mafer•al-l_ -- _------------- ------_-----. <br /> No. of compartments----- --------------Sizeb_-- --------Liquid de0h_ 1 ---------Capacity---- C1a----- <br /> Dis <br /> Disposal Field: Distance from nearest well ___Distance from foundation_- __ _ <br /> p� , , ��...-__-.Distance to nearest lot line--� <br /> Number of lines___.---_ _ __ Length of each line------- - Width of trench.-----. <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 /> ❑ Number of pits----------------------Lining material...-------------------.Size: Diameter--------.--------------Depth-----._-_____-----_------_------ .� <br /> Cesspool: Distance from nearest well----------------Distance from foundation------------------- Lining material--.----------.-------------_--------. <br /> ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity---------•---- ------------Aalsd <br /> Privy: Distance from nearest•well--.-----_--------------_-_------_--------- Distance from nearest building----------------------------------------- <br /> ❑ Distance to nearest lot fine---------------------- -------------------------------- ---------------`------- ------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):` --------------------------•----------•----------------------------•--•-----------•--------------•---•------------•----------- <br /> ----------- <br /> ---------------------------------------------- -------------------------•--------------------------------------•-------------------------------------•---- t-----------------------•--•------------------------- <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 Xws, and 4 e :and regulations of the San Joaquin Local Health District. <br /> (Signed)............ Af-------- ------------------- ---------------------------------------------- -------------------------- -----(Owner and/or Contractor) <br /> By:----------------------�---f ------•--------------------------------------------------------------------------(Title)-- `� ------------------------ ------"--------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION <br /> REVIEWED BY--ACCEPTED BY------------- ----- -- --------------------------- -S�---- - -------------------------- DATE r ._ <br /> BUILDING PERMIT ISSUED------------------ ---------------=---------------------------------•---•----------------------.­-- DATE <br /> A#era#io and or recommgnda ions '--_- ----- -- }---------•----•-----�•- r ---------- <br /> zbf <br /> e,' r. <br /> - - '----------------1-- ---- --- --••-------------------- - ------------ <br /> } p t 1. <br /> (FINAL INSPECTION BY:-__�`' <br /> ----------- <br /> - �' �"�� " '�� <br /> ...--- <br /> Date. <br /> AtOAQUIN 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-4-2M Revised W-2100 <br />