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' APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 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. 49. <br /> JOB ADDRESS AND LOCATION----+- 0 � !------ <br /> Owner's Name---/�' --•---11---------••----------------------­ ------------------------------------------- -------------- Phone------------------------------------ <br /> Address-_....'_ 90,•- -----...--. - <br /> Contractor's Name____ ------------------------------------------------------------ Phone, $--- -- - -- -- ° <br /> : . <br /> Installation will serve: Residence ' partment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J_____ Number of bedrooms .2.--Number of baths ._f.._. Lot size J.`�----- <br /> X <br /> Wafer Supply: Public system 6--C-ommunity system ❑ Private ❑ Depth to Water Tables--oft. <br /> Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe- --1' rIS"dpan ❑ ; <br /> Previous Application Made: Yes [❑ No [4—_Alew Construction: Yes ❑ No �1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi rTar�k: Distance from nearest well-_,_--------_____:Distance from foundation_=__-___.t......Material--------------------------------------- <br /> _- _ <br /> Jo. of compartments-------------------------`Size--------------------------------Liquid depth-------------------------Capacity---------------------- <br /> v <br /> ispas I Field: Distance from nearest well-----.............'Distance from foundation_------------------Distance to nearest lot line-------.----_____ <br /> Number of lines------------------------------------Length of each e__:-�------._. -------------- of trench----------------------------------- <br /> Type of filter material--------_---------------Depth of fil er mate ' I__.______-.__________.Total length__-________----_-___________-___________- <br /> Seepage Pit: Distance to nearest well.. .._.__:Dista rom o ati n__:_J_.�1...__. Distance to nearest lot iine___6----------- <br /> bl-- Number of pits-------/------------Lining mat rial_ _____ __________ ____S Diameter__�_i ....Depth P A;_------- <br /> Cesspool: Distance from nearest well______________ istance from fo anon.................... Lining material-_-___---______-___-___-___________ <br /> Size: Diameter--------------------------------------D h--- ------- --- ',Li- uicl: <br /> Privy: Distance from nearest❑ well----.-_-__ `- ____.__-_--_-_-_.--------_Distance from nearedbuilding Q Distance to nearest lot line- ---i------------- ---------------------------------------- <br /> -------------------------------------------------- <br /> Remodeling and/or repairing [describe):-------------------y------------- --- --------.......... -----------------------------------------------------------------------••-- \t <br /> T <br /> --------------------------------------------------------------------------------------------------•--•----------------------- ---= ---------•------------=--------------•-------------- <br /> F i <br /> ________ ____________________________ ____________________________________________________________________ __________________________ <br /> ---------------------------------------------------------•---- 5 <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 of the.San Joaquin Local Health District. <br /> (Signed)---- - - -- --- - ---------- --- ---- Contractor} <br /> ----- --- ----------------------- ------ --- Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------- ---- ---------- --------------------------------- DATE------- - ---•-- ----- --- <br /> REVIEWED BY------------------------------------------------- DATE---------- -- <br /> BUILDING PERMIT ISSUED. -� I---------- --- - DATE. - . <br /> Alterations and/or recommendations--- --------------- -- -----------------------------------------------`------------------------• -- ...... - <br /> -------------------- <br /> ------- ------- --- -------------- --- <br /> ------------------------•- ---------------------•----- <br /> ---------------------------- --- r7 -------�=- <br /> I <br /> ------------------------------------------------------------------- ------------------- ...... -------- -------- -------- --- --------------- ----------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:--------- --------------------- Date--- ---- ----~-S-------------- <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 Manteea, California Tracy, California <br /> E5-9-2M 145446 ATWOOO 12-s4 <br />