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APPLICATION FOR SANITATION PERMIT Permit No. -- <br /> 1 (Complete in Duplicate) <br /> F ) Date <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to 5onstruct and install the work herein described. <br /> This application is,made in compliance with County Ordinance No. 549. <br /> 4n ------------------------ <br /> - -�-ate- --�-- <br /> JOB ADDRESS AND L TION <br /> Ph <br /> Owner's Name----------------- <br /> S. . ---------•------ --- '1 o <br /> --- �`�---•--------•------------ --- ---------•-----------...---------------------- ----••-----•--------------------------- <br /> Address---...----------------------------- <br /> Contractor's Name---------------- ---- <br /> C---.--------------------------------------- Phone-----------------------­---------- <br /> O <br /> Installation will serve: Residence M--A�`partment House F1Commercial ❑ Trailer Court ❑ Motel ❑ Other [I_ r <br /> ! Q ---c-=- - ------ <br /> Number of living units: _-/-_-- Number of bedrooms _Num��pfh <br /> baths --_r.__ Lot size _-�_ r- ( <br /> Water Supply: Public system ❑ Community system ❑ Private to Wafter Table ---_ #. 4— <br /> Water <br /> Sand Loam El <br /> Clay Loam E] Clay E] Adobe [3 Hardpan E]Grave <br /> Character of soil to a depth of 3 feet: Sand ❑ ❑ Y <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 /> ptic Ta k: S Distance from nearest we}4_----..--_-----Distance from foundation-------------- -----Material_--_---.--_-_----_-----_____.-------------_-- <br /> No. of compartments-- ---------- ------------Size-------------------------------- <br /> Distance <br /> -------------------------- -- Liquid depth Capacity <br /> pose d: Distance from nearest well-----------------Distance from foundation <br /> ----_---------..-.--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 /> f <br /> Distance to neare t well_!- — -------- <br /> -__ Distanc f m f unda#ion <br /> -- -------------Dis#ante to neares of lie--�_+.1--- -- <br /> Seepage -- <br /> ��![ Size: Diameter- /� Depth <br /> Number of pits._!------------------Lining material --__-___ JJ <br /> Cesspool: Distance from nearest well------------- from foundation_________________..Lining material--..-____---__----_-.--_-----__----s33 . <br /> -----Depth------------------------------------ ---------------Liquid Capacity-------------------- gals. <br /> F-1 Size: Diameter------------------ ---------- - - <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest- building-------------------------------- -------- - <br /> ❑ <br /> Distance to nearest lot 1ine--------------------------------------------- ...------ <br /> --------------- ------ <br /> Remodeling and/or repairing (describe):------- ------- ----------------- <br /> - ty <br /> -----------------------I <br /> ---------------------------------•------------------- =-= --------------------------------------- <br /> --------- <br /> ------------------------- ------- ------- --I hereby cer+-ify that I h ve prep red p catio and that the work will be done in accordance with San Joaquin ounordinances, State I ,` ulean reguof the San Jo uikLoal Health District. <br /> Contractor) <br /> Si ned ------- <br /> By: <br /> (Plot plan, showing size of lot, Iota#tan of system in relation <br /> ------ <br /> Awe buildings, etc., an be place on reverse side). i <br /> FOR DEPARTMENT USE ONLY <br /> DATEArl <br /> / = <br /> APPLICATION ACCEPTED BY--------------------------------------------------- DATEI ------ <br /> REVIEWED BY------------------------------ --------------------------- <br /> - - <br /> BUILDING PERMIT 155U -------------••------------------ --------- -------- ---- <br /> ------------------------- <br /> Alterations and/or recommendations:----------------- ------------- <br /> -------- ------- -------------------••----------- <br /> ------ <br /> FINAL INSPECTION BY: - ------ -•---- ------ �` ---- <br /> Date----- ---- <br /> Sx---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 5 camore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street y Tracy, California <br /> Stockton, California Lodi, California Manteca, California Y <br />