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APPLICATION FOR SANITATION PERMIT Permit No_ _____ ________________ <br /> (Complete in Duplicate) <br /> Date Issued -------________________ <br /> Applica;ion is hereby made to fhe 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 /> [f <br /> JOB ADDRESS AND �LOCATICIN -z = �" --------------------------- ---------------------------------------------------------------------------------------- <br /> Owner`s Name.._ � i ---�� - -------- - ---- - ------------------------------ Phone <br /> l - <br /> Address--------------- -`4-`f--- ---`... --- ------s---..... <br /> j. <br /> Contractors Name--- :: .-_-------- Phone--------------------- <br /> r <br /> Installation will serve- Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units- -_ umber of bedrooms ---- Number of baths --�---. Lot size _._6_l�._ f� _ <br /> Water Supply: Public system [Community, system ❑ Private ❑ Depth to Water Table ___L_ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay,Loam Clay ❑ Adobe QHardpan ❑ <br /> Previous Application Made: Yes ❑T No 10/ New Construction: Yes JE/No ❑ OV <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _ . <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.] <br /> x( ""VSe tic 'ank: Distance from st e l-__ __ istance from foundation____ Mate gal_- _ ____ _ gr <br /> p No. of comparttos. A. - ------------------------Liquid depth- Capacity `� � <br /> ....._ -_Distance from foundation _ Distance to nearest lot I _ <br /> ,f <br /> Dispo�sai'Field: Distance from nearest well-44O. —Distance [-pj--- ; �(�ili-- <br /> 3I. Number of lines__________ _____'lam_ ______ _Length of each line-------- - "^ .Width of trench._____.'+______ <br /> Type of filter materia_._ ' ' Depth of filter material--------- Total length------------- _A.D---__--__---__-_ <br /> Seepage Pit: Distance to nearest well-.__._._ ____ 7 ----Distance from foundation___________________.Distance to nearest lot line_______________ <br /> (� Number of pits -----------------Lining material----------------------.Size:r Diameter-------------------- Depth--------------------------------- <br /> Cesspool: Distance from nearest well------------------Distance from foundation....................Lining material----.._�__..---.---------_--_-__---- <br /> ❑ Size: Diameter- t--------------------------------- Depth----------------------------------- ----------------Liquid Capacity ---------•------ --------gals. <br /> Privy. Distance from nearest well-------------------= - ---------Distance from nearest building------------------------------------------ <br /> E] ___._-:____.______-_..__.❑... Distance to nearest lot line--=------------- :------------------------- -----------------­------ ------------------------------------------------------ ---- } <br /> # I ------ ------------- ----------- ----­------------------------- :---•--•------------•----•-------------•------•-----•---•---- V <br /> Remodeling and/or repairing (descriibe)________________ _ __ - <br /> ------------------------- ---------------------=---------------•-••-----------------------------------•-•--------------------=----------------.--------------------------- ----------•--------------------------- <br /> - <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and guiations of the San-,Joaquin oval Health District. <br /> ,�� <br /> 4 <br /> (Signed)s --•- -------- ----------- -- -'�='"� 4 . . ------. . ------ --=: --�-------------= ------=-(Owner and/or Contractor) <br /> By• ----------------------------------------------------•---------------------'---- 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 BY DATES ------------------------------------------------------ <br /> REVIEWED BY------------------------------ DATE - <br /> 1 <br /> BUILDINGPERMIT ISSUED------------------------------------------------------ ---------=------------------------------------- DATE.__._2'%i ----------------------- ---:-----_---_--- <br /> Alterationsand/or recommendations---------------------- -----------------------------....-•------------------•---------------:---------------------•------•-----•----•-------- <br /> --- - - --•------------•- ----------------•------- I-------=------ - --------------------------•------------------------------------------------------......................................................... <br /> ---------- --------------------------------- ------ ------'----------------------------------------- -------------------------------------------- ------------------------------...------•--•---••------.-----•----•------------ <br /> -----.-----•----------•------------•----------•----- } _ - <br /> ----------I---• ---------•------------------------ - --------------- ---------------- ---- - <br /> FINAL INSPECTION `B -- - --- ------------------' n Date-------- e -------- 'a ------------ <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 145446 ATWOOO 12-54 <br />