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APPLICATION FOR_SANITATION PERMIT Permit No. <br /> ---------------- -------------------------- - {Complete in Duplicate) <br /> Date Issued <br /> ---------------- <br /> This Permit Expires 1 Year From 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. <br /> This application is made in compliance with County Ordinance No. S49. <br /> JOBADDRESS AND LOCATION.�.�-------A� ---r ------------------------------------------------------------------------------------------------- <br /> Owner's Name....?1----- - .,11A r.".L'/1 -------------------------------------- Phone------------------------------- <br /> ----------••--------- --- ----- ----------- <br /> Address -----•--------••--•--------•------------------------------••----------------------------------..-------------------------------•--- <br /> f <br /> Contractor's Name----- --- 11 ------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence @�J-­Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Y_____ Number of bedrooms __.Z-Number of baths __/____ Lot size __. .----/J -------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tables$Mt, , <br /> Character of soil to a depth of 3 feet: Sand ❑ _Gravel ❑ Sandy Loam El Clay Loam El Clay [-] Adobe El'-Hardpan ❑ <br /> Previous Application Made: (If yes,date___________________) No �ew Construction: Yes ❑ No Fj- A/VA: Yes ❑ No R!�- " <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permifted,if public sewer is available within 200 feet.) <br /> Se&ialk Distance from nearest well------------- Distance from foundation-------------------.Material----________________._____-----_________._-_-. <br /> No. of compartments------------ - ------Size--------------------------------Liquid depth--------------------------Capacity-•---- ---------- --- <br /> Disposal i Distance from nearest well------------------Distance from foundation---A0-----------Distance to nearest lot lune__S_-____. n <br /> Number of lines_ __ ___�_ j ______--___._Length of each line__G.S�_--------------_Width of trench-Z�__,______-__----___.___ <br /> Type of filter materia4.1� C.- C_______Depth of filter material____/4-- _Total length_-_-__S^A_ ______-_________.___. <br /> Pit: Distance to nearest well_____'_ Distance fr��n� foundation-----A?----____-Distance to nearest lot line_ ------------ <br /> Seepage <br /> bNumber of pits.._./---------------Lining material-__'___1r4.' ---Size: Diameter._O-Z..--__-Depth___ -` <br /> Cesspool: Distance from nearest well--------.--------Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ Size: Diameter- Depth <br /> ----------Liquid Capacity---------------------------gals. <br /> f <br /> Privy: Distance from nearest well -- ------ ------ ------------- - ---____Distance from nearest building. - -------- -------------------- -. <br /> ❑ Distance to nearest lot line----- ------------------ --- ----------- <br /> ------------------------------------------------------------------------- - ------------------------ <br /> - <br /> Remodeling and/or repairing (descrIibe):------------------ --- -----------------------------------------•-------- ------------------------------------------------------------ j <br /> ------------------------------------------------------- <br /> k _--•----------------------- ------- � ------------------- ---- -------- ------------------------------------------------- <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 regulations f the San Joaquin Local Health District. <br /> __ --- ------------ ------------- <br /> (Signed) <br /> {®vrner anlor Contractor) <br /> i ------------------------- t <br /> Tale <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__ -C� ---------- <br /> DATE------ z - � _6 <br /> REVIEWED BY-----------------------------------i ........ ---------------------------- ----------------------------------------- DATE----------------------------------------- ------------------- <br /> ------ <br /> fBUILDING PERMIT ISSUED------------- ----- ------------ , / DATE---------------------------------------- ------------------ <br /> Alterations and/or recommendations:---- ,6 3 2=�A <br /> --------- ---------------------------------------------- <br /> ---------------------------- - <br /> ----- <br /> r <br /> FINAL INSPECTION BY:.. .- ------------ Date... = - ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> FF.P.C❑. <br />