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�. APPLICATION FOR SANITATION PERMIT Permit No. _60a-sl <br /> t <br /> li <br /> D <br /> i <br /> C <br /> ( omplete n Duplicate) 3 <br /> f Date Issued _____ <br /> �/--- - <br /> Applica{ion 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 9rdinance No. 549. t <br /> r . <br /> JOB ADDRESS ANDOC ION j -�' ' <br /> Owner's Name.------ ------ ----------------------------- ------------------ ----------------- Phone. _,f.?,( ---k_'_ <br /> Address-------------------------5---- ----- <br /> Contractor's Name---- Phone. Ex <br /> installation will serve: :Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___I�--- Number of bedrooms _-Y Number of baths ---/__ Lot size _____ __�--Via________________ <br /> Water'Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4-oft. <br /> Character of soil to a depth of 3 feet: 'Sand ,• Gravel El Sandy Loam E] Clay Loam E] Clay E] Adobe-�ardpan El <br /> Previous Application Made: Yes El" No New Construction: Yes E] N.0 ❑ # Q�ltdbf17 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I = <br /> (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) L <br /> cJa Distance from nearest well________________'Distance from foundation--------------------Material------------------------.._-_ <br /> : r <br /> No. of conipartm#nts------------------------'Size--------------------------------Liquid depth-----------------------------Capacity---------------------- <br /> os�l • Id: Distance from nearest well________________!Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number of,lines---------------_------------ _-"}Length of each line--_'--_______-:__-_________-Width'of trench________________________-_ <br /> - --------- <br /> Type of filter material--------------1-.------Depth of filter material-----------------------Total length-- ----•- ----_---------------- <br /> Seepage <br /> ---.._--------------- <br /> Seepage P't: Distance to nearest well- -Q(� _ __._Distanc fr foundation__1�_____'____.Distance to.nearest lot line_-__ __-_-.._ <br /> [ Number of! its------I---------------Linin material_�� . Size: Diameter_-- PO - _ De p t i _ .----•..---___-- <br /> Cesspool: Distance from nearest well________________Distance from foundation---------------- ____.Lining material--_--.___}___________________________- V <br /> ❑ Size: Diameter---:_4------------------ ----------- Depth------------------------------.:---------------------Liquid Capacity-------=---------------------gals. <br /> Priv Distance from nearest well---------------------------------------------------bisfdrice from nearest building1 <br /> ❑ - ^ Distance to nearest lot line._.___.._:__________-_. - r <br /> tt a � <br /> Remodeling and/or repairing (describe):------------------------------------- ------------•-•------- 1 ----------- <br /> ---------••---•--•---•---------------------------------------• ---------=------------------------------------------------------------------------------------------------------------------------=--=------------------------ <br />► 3 I <br /> - ---- --- <br /> ------•---`------- -------------------- ------•------r--•-•---=-------------- --------- - ----- <br /> I he by•certify at I have p a ed t ' plication an t at the work will be done in accordance with San Joaquin County <br /> ordinance ws, and riles egulatio -of the an Joaquin Local Heal District. <br /> (Signed) ----- - vContractor <br /> g )--------- - - - - -----� --------------- <br /> P <br /> I <br /> By:-------------- ---------------------------=--------------------- ---------- -•----- ----------- -- ------ =-(Title)_-- ----------(Plot plan, showing size of lot, location of system in re do to wells, buildings tc., can be l ed on reverse side). ' <br /> FOR.DEPARTMENT USE OtTILY <br /> APPLICATION ACCEPTED BY--------- <br /> -- --------------------- -------------------------- DATE----- -- ----------------------------------------------- <br /> REVIEWEDBY ----------- ----- -------------------------------------- ------=---------------------- DATE----- ----- jar -------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------ --- --- ------------------------------- ------ DATE------- --- --- -------------------------------- <br /> Alterations and/oi recommendations ---------- .............................•-------------------------------------------------------- ---•-----%,v---••-•-•------------------- <br /> f <br /> --------------------------•------------=- ---- --------------------------------- = - --- ----- -------------------------------------- <br /> -----•-••_---•-•---------------------------------------------------•••------------------•-------------------------------------•---•----------------------------------------------­­---------------------------------------_ <br /> 'i <br /> ---------------------------------- <br /> FINAL INSPECTION BY:. -------- Date = = ------------------------------I-—----------------- <br /> - <br /> S <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 /> ES-9-2M ; Revised W-2100 1 <br />