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APPLICATION FOR SANITATION PERMIT Permit No. .-lu..�� _ <br /> (CompleteinDuplicate) <br /> 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 described. <br /> This application is made in compliance wA County Ordinance NWrA,19. <br /> JOB ADDRESS OCATION � $ p <br /> Owner's Name------- -- -----•-.- <br /> -. ---••--------------•------- -------- ------- <br /> ------------ Phone <br /> Address----- <br /> -- -------------------------------------------•------------------------ ------------ ---------- ------------------ <br /> Contractor's Name---------- <br /> ----------------- ----------------------------- -------------------------------------------------------- Phone-..-... <br /> Installation will serve: ResidenceKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: :-I----- Number of bedrooms .-y- N mber of baths .J----- Lot size _-7-- ____ _• Q <br /> ---------•------- <br /> Wafer Supply: Public-:System ❑ Community system ❑ Private' Depth to Water Table 4g-0 ft. <br /> Character of soil to a depth of 3 feet: Sand.E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application.Made: Yes E] No�New Construction: Yes ElNoZ< <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> '1­ <br /> Distance Distance fropm nearest well-_--.._-_._-___Distance_�rom foundation-------------------- _-__.-__-.______ <br /> of compartments-. ----Size---------------------------------Liquid depth------------------------- Capacity---------------------- <br /> . - f <br /> Disposal Field: Distance from nearest well....- <br /> ')„�----Distance from foundation---.[-c�----------Distance to nearest lot line--_-�,__�__•_, <br /> Number of lines-- ------ <br /> - _ en th of each.line-----�.-CT-11r .-..__.-.Width of french-----)-�_�_-Q--__•--- <br /> Type of filter material- _ _}}- - _ pf6 Iter material-_�_$--__---__-__-Total length_-__1 _- __ <br /> --------------------- <br /> Seeps a Pit: , Distance to nearest well---- r <br /> �'- ._._,,Distance fro foundation-----ZB_.-_._..Distance to nearest lot <br /> Number of pits.. :----------------Lining material__ -- a(t0l" } <br /> diameter--- Dept ,J- ---------------•--- <br /> Cesspool: Distance from nearest well------------------Distance from foundation----------------- Lining material--------------------------- ._ <br /> El <br /> Size: Diameter = DepthOr- <br /> _V- ------------------- -------Liquid Capacity---------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building <br /> ❑ Distance to nearest lot line.-.-- <br /> p <br /> Remodeling and/or repairing (describe <br /> ;•- ------- - ------ - -----•----- - -------- ---- - <br /> - ------------- <br /> -----•--------- <br /> I hereby certify that l have prepared this application and +hat'fge 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)-------f.---- �raBY <br /> -- - --- ------------- - <br /> - ----------------------------------------- ------------------ <br /> -- <br /> ---------- - ---------------------------(Owner and/or Contractor) <br /> - - <br /> By:------------- ` <br /> ------------------------------------------- ----------(Title)------------ <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY...........' :...... <br /> DATE..- �/ ----------------•----- -------------- - <br /> REVIEWED BY--------------------------------- <br /> Y-------------------------------- - ------ ---------------------. --- ---- •------------ - DATE <br /> BUILDING PERMIT ISSUED-------------- ---------------------------------------- ------ DAT <br /> Alterations and/or recommendations-------------------------- <br /> ---------•----- - <br /> --•------•-------•-----------------••----•------ ------ <br /> •----•-•---------------------------------- <br /> •-- <br /> FINAL INSPECTION BY:.----- _Ir- Date....--.q!.. �' Y <br /> ------------------------------------ <br /> SAN JOAQUIN LOCAL, HEALTH DISTRICT <br /> e 130 South American Streot 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E$-9-2M 745446-W030 12-54 - <br />