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APPLICATION FOR SANITATION PERMIT Permit No.&..�J!`_-T------- <br /> �Com(Complete in Duplicate) -f <br /> P p � Date Issued�� !q.._t__.__ <br /> pplica{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 County Or ynancerN6. 549. <br /> JOB ADDRESS AW LOCATION--- ----- <br /> Owner's Name----- -- ! %� - ---- --- _L-----••-� --------------- ---- ----- -- -----------------------P--h--o--n-e---­----------r------- <br /> Address-------- ----------- �---e � ' � = i----i---------------------------- ----•---.. -------------------------------... --- <br /> Contractor's Name-- —!_Q:1 ------------------ 0--------------------------------------------------------------••-- <br /> ---------------- Phone------------------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other <br /> -�/7y <br /> Number of living units: ��Community <br /> umber of bedrooms _Y'1�__. Number of baths __�__-. Lot,size _��__�_�_1-_�___ _____________ <br /> Water Supply: Pubtic system system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ ;(No <br /> Gravel El LoClay Loam ❑ Clay E] Adobe Hardpan E] a <br /> Previous Application Made: Yes No ,+�u� New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if py lic sewer is available within 200 feet} + I <br /> Se tic Tank: Distance from nearesr well'__ ____ istaric.e fr fo dation____ _____________. ate alb_________________.__ ___ ____ <br /> p� No, of compartments_.._____-__ .____ _5ize _ { C` __----Liquid depth _`T'_______-___Capacity____C1 <br /> Dispo 'I Field: Distance from nearest wer�`"'f?is}ance�from faunation__l __�_.f_ _ istance to nearest lot lin _f I' <br /> J Number of lines________ '_-_-_-- _Length.of each line_ ____________ _______ _Tr_.Width of trench.______ �_ry__�__________ <br /> Type of filter mates f epth of filter material____.___.!__ Total _-_________-- . 1 <br /> Seepage Pit: Distance to nearest well______:-_____________Di Vtanceifrom foundation--------------------Distance to nearest lot line__________.______ r <br /> ❑ Number of pits----------------------Lining material-~----i........._Lsize: Diameter-----------------------Depth--------------------------------- N <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_____.____..____.__.Lining material--------..____._________________------ <br /> Size: Diameter--------=----------------------------Depth ---- I--------------------------- -- -------------Liquid Capacity --- -----gals. <br /> _ Privy:F- ,Distance from nearest well--------------------------------- --------------Distance from nearest"building____._____.___________________.__________. <br /> ❑ Distance to'nearest lot line---------------------------------- _ <br /> = ing------------------------------------------ <br /> ---------------------------- �y <br /> 1 0 <br /> Remodeling and/or rep <br /> ' airing (describe):________________________----------------------------------------------------------------------`-------------------------------------------------------- T <br /> r <br /> 1 <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, State laws, and rules and regulations of the San Joaquin Local Health.Disfrict. <br /> (Signe71d) -------------- - ---------------------------- ------------- ------_-----_.N... -------------------------------(Owner and/or Contractor) <br /> By: ----------------------------------------------• - (Title) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,!an be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B V <br /> ----------------------------- -------- I------ ----------------------------- DAT �------------------------------------------------------ <br /> REVIEWEDBY------------------------- -------------------------- I-------- DATE-- <br /> BUILDING PERMIT ISSUED----- -----------------------------------•---------------•------------------------- DATE......... <br /> and/or recommendations------------------------------------------------------•--. ------- ---- --------- <br /> , ,. -- vs-- <br /> � ' •-•---- ---•------------ <br /> ------------------------------------- ------------------------ -------•--------- <br /> FINAL INSPECTION -BY----------`Q---- --4-------------- Date-----------.`s"--G� <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 /> rr-9-9U - uav;tAe4 w_ainn <br />