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APPLICATION FOR SANITATION PERMIT Permit No. ._3_a_ __ __.. <br /> �--> 2— (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District far a rmit to construct and install t ' work herein described. <br /> I <br /> This application is made in compliance wit ounfy Ordinance No. 5 l <br /> JOBADDRESS AND ..- ------------•- ---0---------- --- --- --------- -- ----------- -- -- - -------------------- ------- <br /> Owner's Name--------- _ ---------- Phone___ --- _--__ <br /> Address. q r ---------- --------- -- --------------------------------•-------------------------- <br /> f r G/ <br /> Contractor's Name.. t t � '�` f Phone- .,9' <br /> hone. &P-7----------- <br /> Contractor's <br /> Installation will serve: Residence { Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1_____ Number of bedrooms _ !_ Number of baths _J____ Lot size .__&p.1�7X---I-AS----------------------- <br /> Water Supply: Public system )d Community system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet Sand ❑ 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 /> Septic, Tank: Distance from nearest elV72(7YEC_Distance from foundation__le_--_----.Ma eri�l _". W-LL&I---.---- -___ <br /> No. of compartments-_�!______-------Size_.S�TSk_J.i_-Da Liquid depth--- --------------Capaci <br /> Disposal Field: Distance from neare t well_ i�.�Distance from foundation___ <br /> �Q_________.Distance to nearest lot line__..ZQ_!.__ <br /> Number of lines_____ ____. __ Length of each line__c _ Width of trench ----------------- <br /> t , <br /> Type of filter material- __-�_. ._Depth of filter material______ __________Total length______ __ <br /> Seepa e Pit: Distance to nearest wa I_-__% ;�� —Distance rom_f ndation__le__�__.__.Distance to nearest to line---�r______ <br /> Number of its__ _ _Linin material__ b�.�' __Size: Diamefer_:. ,_f�_____Depth--- _________________ <br /> p' (� ti 9 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------------------- <br /> ❑ Size: Diameter T---------------------- <br /> Depth Liquid Capacity gals. <br /> r <br /> Privy: Distance from nearest well____---------------------------------------------Distance from nearest building------___---___-_________________-_____. <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)------ -- ----------------*andhat; <br /> -------- -----•--------------- ------------- -- - -------- ---------- ---- <br /> a <br /> = >------------ <br /> -----------------------------------------------------------­:---- -- ---- -- ------.--- -------- --- - <br /> ------- ---------------------------------------------------------------------------------------- --------------------- . _._..------------------------------ --------------------------- -- <br /> hereby certify at I have pre 'a this applicationthe work wil be done in accordance ith San Joagw County <br /> ordinances, State sand ules and1,'re ulations of th an Joaq ' Local a District. <br /> (Signed) { o ? + wner•and/or ntract ] <br /> By:----------- - ( ------------- 1.e�1r (Title)---------- -------- <br /> (Plot plan, showing size of lot, location of system in lation to wells, buildings, etc., can be placer on reverse side). <br /> Y <br /> k FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------- ----------------• - - -- '------------ ----------------=----------------------- DATE------- ` '---------- <br /> REVIEWEDBY----------------------------------------------------------------------------- - ---------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED --------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations----------------------- -- ----------------- - -----------------------------------------------------------------------------------------------------•-------- <br /> ---------------------------------------------------------------------- ------------- ------------------ -------------------------------------------------------------------------------------------- <br /> ------------------------------------ --------- ---------------------- <br /> F 2. <br /> FINAL INSPECTION BY:---------- fi -- - <br /> --------------- <br /> D ------------------------------------- <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 5-51 Revised W-2100 <br />