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APPLICATION FOR SANITATION PERMIT Permit No. --�f. '"�- --- <br /> (Complete in Duplicate) <br /> Date Issued ____l <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 compliance with County Ordinance No. 549. <br /> thf.t_ <br /> JOB ADDRESS AND LOCA ION- 4 °!t' ------------------- <br /> Owner's Name- ---- --------------------------------------------------- --------------------------------------- Phone---- •------------------------------ <br /> Address._...- ---- 1 ---- -----Vt- --------------- <br /> ' ' <br /> Contractors Name_____�:A____Apa_rtment__H_ouse__0 <br /> ---•-- •- •----- --------- -----------�------------ - -- --- ----------------•-----�----�------ ----- Phone------•--------------------------- <br /> Installation will serve: Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1-.--- Number of bedrooms _4L__ Number of baths 1______ Lot size __1?--- --------------------------------- <br /> Wafer Supply: Public system❑ Communi"ty`system ❑- Priva-te ❑ Depth to Water Table , ,ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sancly Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ PHA/VA: 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 well_________________Distance from foundation--------------------Material _____________._-___-_-__.___-_______.________- <br /> ❑ No. of compartments------------- - ----------Size--------------------------------Liquid depth---------------- ---------Capacity--------.............. <br /> Disposal Field: Distance from nearest well--- - a Distance from foundatio,J � ___ --------Distance to nearest lot line----------------- <br /> Numberi.of lines------- ------------- <br /> --- -- -------------Length of each line-- --0---f------------Width of trench___±- --------------- _-- I <br /> } Type of filter materiaepth of filter material-----/1'"________Total length_++5_r__Q_ _____________________________ <br /> Seepage Pit: Distance to nearest we ____.f�_t?______.-Distance from foundation---l ---------.Distance to <br /> Number of pits-----/---------------Lining materialvlr�__._-.-----Size: Diameter___.________-____.De thjs_�_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------.____.Lining <br /> ❑ Size: Diameter-------------------- ----.-------------Depth_--------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------- <br /> Distance from nearest building----------------__--_--___._____________. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------•------ ---------------------- <br /> ------------------------ ---------- <br /> Remodeling and/or repairing (describe): _ "" - <br /> --- -- --- -- ------ -- ---------------=--•------------------------------------------------------------------------------------------------ ----------------------------------- <br /> --------------- <br /> ---- ---------------------------- <br /> - - - --------- -- - ----• ---- ---- - X11 <br /> ------------------------------------------•----------------•-----------------•--------•-------------------------------------------------­­----------------------------1-1------------------------------------------------- <br /> I hereby certify that I have prepared this application an-dL That the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, an rules and regulations of the San `.Joaquin Local Health District. <br /> .1. (Owner and/or-Cantractor�)(Signed)--------- -------- -- ---J =------------------------------------------------------------- <br /> By:--------------------------•--•------------------------------------ - <br /> � <br /> 1--- \----------•-----------------------(Title)------------------------------------ ----------- --------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells;,buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYA_ .:= =-------------------------.------------------- DATE_?. --=`rJr------•-------------------- <br /> REVIEWED BY--- ; ` ' # # '_ ---------------- DATE---------------- --•------------------------------------ <br /> t �'---------- DATE--------------------•-----•----------------------------•----- <br /> BUILDING PERMIT ISSUED-"--------,°------------------------ -;�;_.'' - <br /> Alterations and/or recommendations:--------•--==---------------------------------- ------------------------------------------- ---------•-------------------------------- <br /> *-- # <br /> w <br /> -------------------------------------------------------------------- ----- -----------`- --. <br /> FINAL INSPECTION BY:.-------- �t "' _ Date---- ---------------------------------------- <br /> SAN JOAQUIN LL A 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 , Revised 1-57 F.P.CO- <br />