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APPLICATION FOR SANITATION PERMIT Permit No. ...JJ�..�.13.__._ <br /> (Complete in Duplicate) Date Issued <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des <br /> cribed. <br /> This application is made in com liance with County Ordinance No. 549, QHS_ 0,(On-0 <br /> 1433��,•�j ) �JOB ADDRESS AND LOCATION., � '� / <br /> + . <br /> ----- <br /> Owner's Name f---h-.•'�'-•------ y,¢----------------•-------------------------------- ------ ----- -------------------------------------- Phone-----------•------------------------ <br /> Address................4/x------- <br /> Contractor's Name----;� - -"------------------------------------------------------ ---•-------------------------------------•-----••----•------- Phone----------------------------------- <br /> Insfallafion will serve: Residence .® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ____1__ Number of bedrooms _,�--- Number of baths __.I____ Lot size -----7A_�`_.���5' <br /> ---------- <br /> Water Supply: Public system ❑ Community system ❑ PrivateR Depth to Wafer Table�__►t_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Q New Construction: Yes 2d No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__-i-F0_____Disfan a from foundation.-. . - <br /> p --•------.Material-------- <br /> ---- - ---------...--------- --.... <br /> No. of compartments- A+---------------Size-- -t_a "'t_ -•-_ ---Liquid depth....A�--------.--------Capacity--- --------- <br /> Disposal Field: Distance from nearest weli_.S�!--------Distance from foundation---�•�•-�-.__.-- Distance to nearest lot line---s ------- <br /> ® Number of lines---- ------j_--�.______�_-r Length of each line---�YO------------ -----Width of trench-aZIK*----------------------- <br /> Type of filter material_��1Depth of filter material---As?-------------Total length----A.2--Q--_______.___________.__,- <br /> ^O <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line___-_-_---__-_._. W <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- ILV <br /> Cesspool: Distance from nearest well-_________.__-__Distance from foundation--------------------Lining material___.________________________________ <br /> ❑ Size: Diameter------------- -r------ --------------Depth----------=----------------------- ----------- -----Liquid Capacity-----------------------------gals. <br /> Privy: Distance from nearest well------ ------------ -----------_---------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line-------------------------------------------------------------------•-•------------------------------------------------------------------------ i <br /> Remodeling and/or repairing (describe)-------------------- - --------------------------------------------------------------•---------------------------•----------------•---------•-------_-•--• V <br /> -------------• -------------------------------------------------------- <br /> -------•-------------------------------------------------------------------------------------•--------------------- ------. ------ •-------------------------------------------------- ---- <br /> 1 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 egulations of the San Joaquin Local Health District. <br /> {Signed} �r'�.: r_,. ------------------------------ ----------------------{Owner and/or Contractor) <br /> B -(Title)_ <br /> (Plot pian, 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- _ . _ .- __�_ ________________________ � <br /> DATE.__y."•. --• ----------------•--- ------------•---- <br /> REVIEWEDBY---------------------------------------------•--------------------------------------•--------------------------------•------- DATE----------------- -•-•----•--------•---- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE._ <br /> - -- -- ------------------------ <br /> Alterations and/or recommendations----------- ---------------------------------------------------•------------------------------------------------------------------------------------------------ <br /> ------------------ <br /> -------------------------------------•------------------------------------------- -----------------------------------••---------------------------I.._....----------------------•-•---------•-•---------------••-•----------- <br /> -----•--•-------------•----•-------------------- --•--- -------------- --------I---------------------------------­---•--- ---------------------------------------------------------- ------------------------------- <br /> -----------------------------------I- ----- ----------------------------------•------------------- -----------------------------------------------------------------------------------------------------------•--------- <br /> FINAL INSPECTION BY:_. . - `""' ! --------- --- Date_..;; 'Z D <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 145446 pTWQDD <br />