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APPLICATION FOR SANITATION PERMIT Permit <br /> ` (Complete in Duplicate} <br /> p.. - 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. 549. <br /> JOBADDRESS AND LOCATION...__Sg_A�------- -----------------g ----------- ---------------------------------------=-------------------==---------- +---------------- r <br /> Owner's Name FNS ------------------------------- -------------------- k Pone + <br /> h-. <br /> ...Y �- --_ �" _ ----------------_------- <br /> Address---------_-------------- ------- - y� "�' <br /> 3 <br /> Contractor's Name_ - �' - ------------------------------------ ----------------------- Phone.--'------- t---------- <br /> - - --- -----------�---------------- - � it <br /> ` Installation will serve: Residence []Apartment House ❑ Commercial ❑ Trailer Court ❑ Motek ❑ Other ❑ <br /> i Number of living units: -_-_____ Number of bedrooms .-____: Number of baths _ _____ Lot-size __ ___. ____ ; <br /> Water Supply: Public system Community system ❑ Private [ _Repth_to.Water <br /> Character of soil to a depth of 3 feet: i Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam <br /> ❑ Clay ❑ Adobe Hardpan ❑ <br /> ' Previous Application Made: Yes ❑ No New Construction: Yes.❑ No E] f S Q <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> c Septic Tank: Distance from nearest wellw�--------Distance from --- --:Jw".Material_+ ____'_ ___________________ -------- <br /> pvi Size_ ----Lid depth th---_-- ----------------- a acitY- -- ---------------- <br /> No. of compartments--------�.c------------. -��---3-��•-- q P CP _ <br /> } Disposal Field: Distance from nearest well_1ta__0_�-_Distance from_foundation"_ ________Distance to nearest lot line__1. !--_____- <br /> Number of lines________ _____________ Length of eac0ine_k_ __._____ Width of tranch_____ __ _��__.____i____-___ <br /> Type of filter material_____--_Depth of filter ------ <br /> Type g ----3-------- <br /> _ Total length <br /> i Seepage Pit: Distance to nearest well----------------------Distance from foundation_________::_____-=Distance to nearest lot <br /> ❑ _ i : - <br /> ' j <br /> line <br /> --------------❑ Nui,:ber of pits----------------------Lining material---:-------------------Size: Diar;ete Det ._-_-___-_____-_____-_w_+_ <br /> ._ <br /> arest well_________________Distance from foundation_____ -']Linin� matera_ �__f__________Cesspool: DistanceFfrom ne <br /> Size: Damter ------------------------------------De th_ Caacitygals. <br /> . <br /> Privy: Distance from nearest well--------------------------------------- Distance from nearest`building ---------- '_-------------------- ¢ <br /> e ❑ Distance to nearest lot,line,--. ----------- -----------------------------------------------------------F------- -- ------ <br /> Remodelingand/or repairing (des cribe)__ _______________---------------------- --------------------------------------------------------- -------------------------------------------- -------- <br /> ' <br /> -------------------------------------------------------------------------------------- ------ ----- <br /> ------------------- ---------------1 <br /> 4 -----------------------------------------------------------------------=--------------------------------------------------------- -`---------------------------- ; <br /> ----- r <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, St a laws, and rules and regulate ns of the San Joaquin Local Health District. <br /> F (Owner and/or Contractor) <br /> ------------------------------------------ <br /> (Signed)--------- - - �� <br /> Y - -•--------------------------------------------------------------------- -----------------(Title)---------------------------------------------------------------- <br /> (Plot p anshowing 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-- — ------------------- DATE ---- ------------------------------------------ <br /> REVIEWED BY----------------------------- -------- _ DATE----- <br /> ' BUILDING PERMIT ISSUEDf <br /> ----------------- DATE----------- � /_�-��------ --------- <br /> Alterationsand/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------- <br /> ----------•---------------•--------------------------------------------------•------------------------------------------------------------------------------------------------------- <br /> ------------------------- ------------------------------------------------------------------------------------- ------------------------------------------------------------------- - <br /> FINAL INSPECTION BY:.------- _57------------------------------------- Date------------ _•--------------------- <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, CaYpinia <br /> ES-4-2M 8-51 Revised W-2100 a <br />