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y t- APPLICATION FOR SANITATION PERMIT Permit No. " - <br /> .. (Complete in Duplicate] <br /> Date Issued <br /> Application is hereby made to the San­1..Jgaquin Local Health District for a permit to construct an <br /> This application is made in compliance with County <br /> Ordinance No. 549. d install the work herein described. <br /> JOB ADDRESS AND LOCATION_____}..___ " <br /> _ _Owner's Name-_ ��� r1f1 - <br /> ------------------------------------ Phone-- <br /> ----------- <br /> hone__ <br /> Address----------- -- - <br /> � -------- ��-�-. ------------�,�------------------- <br /> ------------------------------------------- <br /> Contractor's Name-----------------"__-- _P`_ <br /> Lydi.C.�.S ---------------•------------------ Phone _ __IP_ ------ <br /> Installation will serve: Residen a Apartment House ❑ Commercial 0 Trailer. Court ❑ Motel <br /> - ❑ Other ❑ <br /> Number of living units: fNumber of bedrooms _yNumber of baths __4__ Lot size <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water TableV�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�.pu�bli�c sewer is available within 200 fee+.) <br /> Septic Tank: Distance from nearest well714-w--_Distanc from fo ndation__ Q_�-""" <br /> �{ --Mate ial �� _ __ Ge' <br /> f- No, of compartments___________________ ---------- <br /> v r�---Liquid depth------�-- <br /> S � X ( ----CapacityD- <br /> .-y� - -4 s�.. <br /> Disposal Field: Distance from nearest well-_1"L,Q -Distance from Iodation__-_f�___^_____Distance to nearest fat line__"__ �"" <br /> Number of lines----------/__--- _ - Length of each line_----c_-9 Width of trench______ <br /> 1?- <br /> Type of filter material-___ _ __ -----Depth of filter material____---I ii""-_Total length__t a' `"_" <br /> --------------------- <br /> Seepage Pit: Distance to nearest well__ '_W---Distance from foundation__ <br /> f _______.Distancwta nearest lot lin e_ ----- <br /> Number of pits_ <br /> Cesspool: _______-______" Lining materiai� ----Size: Diameter------- <br /> -Depth- _�----�------------ <br /> Distance from neares-r well---------- Distance from foundation--------------------Lining materia---------- <br /> El Size: Diameter------------------------------- ------Depth--------------------------------------- ---- <br /> - -------Ligwd, Capacity------------- -----------gals. <br /> Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest bAdin <br /> El g <br /> Distance #o nearest lot line .� <br /> Remodeling and/or repairing (describe)---------------------- <br /> -------------------------------------- <br /> _ <br /> ---------------------------------------•----------------- <br /> - --•------"---- <br /> i hereby certify that I ve prepared this applic n and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, a les and regulations the San oaquin Local Health District. <br /> t <br /> (Signed)------- �"---- ----- -1-?�,--- -- <br /> Q,�� ----------------- --------------------1�- <br /> BY� ----- `- - tract <br /> - - ---- ---------------- -----------=.;�--------:-_------ ----=--Title--- --_ � or] <br /> (Plot plan, s owl size of to , ocatian of:sys+e in relation to wells,`�`u'ildings; etc.,.cant be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- <br /> REVIEWED BY-------- - DATE <br /> ----------------------------------------------------------------- DATE-------- <br /> ---------------------------- <br /> BUILDING PERMIT ISSUED------- ------------------------------------------ -- ---------------------------------------- <br /> ------------------------•---------------------------------------- DATE--- <br /> Alterations and/or recommendations:-------:- -----------------------"------ <br /> ------------------•---•-------- <br /> { <br /> ----------------------------------------------- -- <br /> --------------------------------- <br /> -------------------------------- �- - - <br /> FINAL INSPECTION BY:-___--._, v"-_ J <br /> --------------------------------- Date_------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> 814 North "C" Street f <br /> Stockton, California JEodi, California Manteca, Californiej <br /> Tracy, California <br /> ES--•-9-2M-8-51 Revised W-2100 <br />