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+ 1 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... . <br /> (Complete in Duplicate) Date issued .- -A S� <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 with Cou tp-� rdina e No. 549. <br /> JOBADDRESS ND LOCWN.s.?. ------ . ---j- �1----�----------------•--- ------- ----------------------------------------------------- ( ---------- <br /> Owner's Name.... _. ___ .._4__ _ _ - -----•- <br /> ------- - --- -------------- ------------------------------------------.- Phone .) t <br /> Address-_-----------4 --------• -------------------------------------------------------•------------------------------------ <br /> Contractor's Name_ - --------------------------------- -------- Phone------------------------•---------- <br /> Installation will serve: r Residence/ Apartment House ❑ Commercial ❑ Trailer Court 'E] Mote) I-] OtherC]t Number of living units: .WCommunify <br /> ! Number of bedrooms Z_ Number of baths -1_.... Lot size _. _(�__ � ----------------------- <br /> Water Supply: Public system system ❑ Private ❑ Depth to Water Table--------- ft. <br /> Charactp <br /> er of soil to a de th of 3 feet: Sand ❑ Gravel [-] Sandy Lo;?ONO <br /> Clay Loam ❑ Clay E] Adobe Wardpan C]Previous Application Made: Yes ❑ No [u New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if-public se r is available within 200 feet.)r <br /> C f�`e • <br /> Septic ank: Distance from nearest we . istary �Ifrom our ton...... ........... ate ca� <br /> No. of compartments4we'l <br /> --------- ize A _ _Liquid glepth'_-- - ,..-- _..Capacity.-..__ �l _ <br /> Dispos Field: Distance from neare �istance fromfaundation_.._f�. ... istance to nearest to lin .Q.Length of each line..-_. ----.-_ Width of trench-.... _ __Number o� lines - 1------------ <br /> Type of filter materepth of filter material_-_� <br /> - �------------Total length---------- -- - - --------------•-- <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation__-___._.-..._----..Distance to nearest lot me.........__-_..._ <br /> ❑ Number of pits----------------------Lining material----------------------.-Size: Diameter-----------------------Depth-Ir------------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.- __.____..-..Lining material-_,;---------------------------------- <br /> ❑ Size: Diameter----------------------- -----.Depth-----------------------------------------\------- Liquid Capacity_.-------------------------gals. <br /> Privy: Qistance from nearest well--.------------------------------ from.nearesf building--_-----------__----__----------------.--. <br /> ,.t - <br /> ❑ Distance to nearest lot line------------ '-------------------------------------------------------- --------------------------------------------------- <br /> Remodelingand/or repairing (describe) ---------- -------------------------------------------------------------------- --------•---------•--•----------------------------------------- <br /> + ------- ---•-•-----------------•------- <br /> ---- ------------------- -------------------. -------- ------------ -------- ----------------­­--------i-----------•-------------------------�- <br /> -------------------------- -------------------------------•-------------------------------------------------------•-------•-•-------•-••---------------- <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, Sto laws, d rules and Nrellattions. of the San Joaquin Local Health District., <br /> 5ined - --- - ------ =------------------------------------------------------------ ---------------(Owner and/or Contractor) <br /> i + Title <br /> (Plot plan, 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 /> APPLICATIONACCEPTED BY---- -------- ----------------------------------------------•---------------. DATE ' ------ ----------------------------------------- <br /> REVIEWED BY ------------------- ------------------------------ DATE.. <br /> BUILDINGPERMIT ISSUED---------------------------•---------- t ----------------------------------------------------- DATE------ <br /> Alterations and/or recommendations:---------- ------------ ------ ----------------•------------------------------------------ _ -------- ------ �----.......----------------•---..------ <br /> ----------------------•----------------------- ------- -------------------- <br /> i <br /> k ----------------------------------------------....--------------------.-----------------------------------------"""'f.......---------------------- <br /> FINAL INSPECTION •BY:..----== - -" �-� i� Date..------- == = '� ---------------I--------------------- <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 /> Gc—a�9A,1 : R.,�:�Ad W-7100 <br />