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APPLICATION FOR SANITATION PERMIT Permit Nq -_ <br /> ---------- -- <br /> [Complete in Duplicate) <br /> Dafe Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work-herein.deescribed­ <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---------- -----f�-----6T----- �- ------------------- ---------- <br /> Owner s Name-------------�_-------� • - ----------------- ��_____---• <br /> -------r = Phone <br /> Address---------------------------------------- ,:----t•-------------------- ------- -----------------••-----------------•----------------- <br /> ---------------------------- <br /> Contractor's Name-------------------------- --- --------------- Phone------------------------------ <br /> Installation <br /> ---- -----•--------------- <br /> Installation will serve: Residence W--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -L_1_ Number of bedrooms ----f.__ Number of baths -if----- Lot size ----KjF_ ---ar-.:s,,•�----------•-------- <br /> I Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loamay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ew Construction: Yes o <br /> TYPE OF INSTALLATION AND SPECIFICATIONSr <br /> (No septic,tank or cesspool permitted if public sewer is available within 200 feet.) I <br /> Se tic Tank: Distance from nearest well__ distance fro�mm foucdation-___!- --__.Mat ri -_-_---- ---------.-___�________ <br /> 1 No. of compartments-------- ---Size-- - -F�-, --�'�------Liquid depth------- --------------Capacity--- ---- - <br /> Disposal Field: Distance from nearest well _�✓6?2o_Distance from foundation.--_f 0.17_____Distance to nearest lot line`sIF-11 <br /> ____t---- <br /> Number of lines_______________I------------------Length 'of each line----------�__Q-----____-Width of trench-------3^1 L_ <br /> Type of filter.material___ '-) -------.__Depth of filter material--_---I .{___._.Total length-------------�__ .__ _ 44 <br /> I <br /> E Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> F] matNumber of pits <br /> erial-----------------------Size: Diameter-----------------------.Depth--------------------------------- <br /> ( Cesspool: Distance from nearest well-----------------Distance from foundation- material-_---_---_---_----_-__-.__--_--.--_ <br /> Size: Diameter--------- ----------------------------Depth---------------=------------------------------------Liquid Capacity------------------------ gals. <br /> • Privy: Distance from nearell---------------------------------------------- -- i ante rom n—ea r6st`buiid nom_----------_-----=------ ,� <br /> ❑ Distance to nearest lot line----------- ------------------ -_----------------------------_----------------------------------------------------------------------- <br /> i <br /> Remodefi,ng and/or repairing (describe):.---------------------------------------------------------------- ---------------------------------------------------------------------------------- <br /> r ---•-----------•: ----------------------------------•----------------------------------- <br /> -------•--------------------------------------------------- <br /> F + --------------------------------------•------------ <br /> ----------------------------------------------------------- ------ <br /> I neieby 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 of the San Joaquin Local Health District. <br /> (signed) y- ------- s '� r=f -----�� ----------------------(Owner and/or Contractor) <br /> I By------------- ----------- <br /> - -- -- <br /> ------ -------(Title)------------------------------------------------ --------------- <br /> (Plot plan, showing size ellot, 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---------------------------------------- ------------------------------- <br /> ----------------------------------------------------- DATE----------------------------------------------- ------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------------------- <br /> f <br /> - ,-- ------ -- -------- <br /> ---- <br /> - ----;---r-- <br /> -------- -------------------------f <br /> -•--------------------------•-- -------------------------------------- i <br /> ------- - --------------- --------------------•----------- <br /> ------------ - <br /> -------------- <br /> ---------------------------------------------- <br /> -------------------------------------------------------- ._______- _. <br /> -_ --------- ------------------- - --------------------------_-------------.------------------_----------------- <br /> R <br /> i <br /> f <br /> 4 FINAL INSPECTION BY: Date-- ---------------------- ---------------------------------------- <br /> i~ <br /> I SAN`JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Sfocktpn, California Lodi, California Manteca, California Tracy, California <br /> E5--9-2M 8-51 Revised W-2100 <br />