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--- '---•/n.-- <br /> 7 <br /> Permit No. ... ' -'.-. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued /• ' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 5 <br /> This application is made in compliance with County Ordinance No. 549. J <br /> E:----- yr �. p_�L ---------------------------------•-- <br /> JOB ADDRESS AND LOCATION-__ QQ _ --------- <br /> h vr Phone-------------------------------•--- <br /> Owner's Name---------------•--- C. ? __ ' <br /> Address.----------- r'� �-- •------------- - ------------------------------------ ------ -- <br /> Contractor's Name----------------------------- � -�`tt_e,.t---•------ ------ ---------- <br /> - - ------------ ----------------- Phone--- ^_l --------- <br /> Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Installation will serve: Residence ❑ Apartment House.0 ❑ <br /> Number of living units: __I__ Number of bedrooms J_-. Number of baths -------- Lot size ----_` ` -- -------X----/-d­p'_- ----------•- <br /> Water Supply: Public system Cg 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 /> s <br /> Previous Application Made: Yes I] No E] New Construction: Yes ❑ No ❑ C7irs <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> N septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S i� Tank: f Distance from nearest wellDistance from found ation___________________Material---------------------------------------- . <br /> l No. of compartments-- ------------------ ----Size--------------------------------Liquid depth----------- -- - --------Capacity--------- <br /> ' `� .---_-...Distance to nearest lot line--- -.---___ <br /> Di osal i€Id: Distance from near st well___L l per=._.Distance from faundation__l,� ,f <br /> Number of lines-----I.__-_-- Length of, each line----- -Q'---..-------Width of french----- _______________ \ <br /> i s I ------ <br /> Type of filter material___i1__�:.-R4-.__Depth of filter material--- __�'..____-_dotal length------_7�-___Q,�----------------•---- <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----------------- from foundation------------_-.__-.Lining material----------:.----�_-------------_- <br /> ❑ Size: Diameter--------------------------------------Depth------------------------------------------- -------Liquid Capacity-.--------------------------gals: <br /> Privy: Distance from nearest well-_----------------------------------------------Distance from nearest building..___--------_--______-_-_-___---------- <br /> ❑ Distance to nearest lot line- --------------- ----------------------------------------------------- ------ ----------------------------------- --------------------------- <br /> ----------- <br /> I <br /> Remodeling and/or repairing (describe):--------------------- ------------------- ---------------------------------------------------------------------------- <br /> --------------•- -----••-----------•------------. <br /> ------------------------------------------------------- <br /> -i <br /> --=-- --------------------------------------------- i <br /> I ----------------------------------- ------------------ -- <br /> ---------- <br /> -------------------------- <br /> 1 hereby certify that 1 haverepared this application and that the work will-be done in accordance with San Joaquin County <br /> ordinances, State laws, and rulesland regulations-of�fhe San Joaquin Local Health District. <br /> � L Contractor) <br /> (Signed) <br /> Title s A o _­' -- --- <br /> By -------------------- -- )--- <br /> (Plot plan, showing size of lot, location of syste4 in relation to �/eI[s, buildings, etc., can be placed on reverse side). <br /> a <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- -- ------ DATE----- <br /> REVIEWED BY----------------------------- ° DATE <br /> BUILDINGPERMIT ISSUED--------------- ---.._ ---------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations---------------- -T-------------•---------------------••-------------------•---------------------------------------- <br /> ! -•-•-------------•---•------------ ------------------------------------------ <br /> I -----------------------------------•------•---------- •------------•--------------------- <br /> -----•------- -----•--------- -----------•--------- ------------------------------ <br /> k -------------------------------------------------------- •----------------•-- <br /> -------------- rr <br /> 4Date. <br /> FINAL INSPECTION BY.- ---- -- -------------- <br /> ___._..--- <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 /> E5-9-2M 10-52 Revised W-2100 <br />