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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) <br /> Date Issued ._......�sli..'J <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construct end install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 1 JOB ADDRESS AND LOCAION`... .8�� .. G --- <br /> .t Owner's Name—.4 .. n .. .. ...... _ . __ ....__ . .... Phone <br /> ....CJ.'c�q,.it <ws. <br /> ,1 <br /> Address..._... <br /> s,... ......4.- +.:x✓�'1........ ........._... ....... ...._....................._..........!'.�T"_................... <br /> Contractor's Name... .............. Phone....��..... .. y <br /> Installation will serve: Residence Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ It <br /> Number of living units: ...0.. Number of bedrooms L:... Number of baths _?/.... Lot size <br /> Wafer Supply: Public system ❑ Community system ❑ Privatoo—Depth to Water Table _Prff. <br /> Character of soil to a dapfh of? feet: Sand4!l-,Cravol L] Sandy Loam❑ Clay Loam❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 0 Now Construction: Yes ❑ No [X—. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No soptie tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: _.stance, from neorest well .Distance from foundation..................Material.................................... <br /> No. of compartments........s�r..r.. ._.Size................................Liquid depth................. ... .............Capacity <br /> Disposal Field: Distance from nearest well...o62k._._Distance fromfoundation.....1W........Distaace to nearest lot line....L...... <br /> ... <br /> Number of lines............ <br /> Length of each line....... -,L~!.........Width of trench...Y...'1'-.�....._.........._ <br /> Type of filter meteriel..f..i��.. !\..Depth of filter materiel_..le ��.....Total length....... <br /> �...Distance�om fo dation.. ...v 4. f <br /> Seepage Pit: Distance to nearest well... 0? . � }�^ �.....Distance+o nearest lot line sJ <br /> Number ^f pits.......�/ .Lining material...;4=_.Size: Diameter....4e.. .....'..Depth.../.(.'9 ' � i.. <br /> Cesspool: Distance from nearest well ...._........Distance from foundation...................Lining material............ F <br /> i ❑ Size: Diameter..............__......._..._...._Depth..._......._....._................................Liquid Capacity............................gals. <br /> Privy: Disfnnce from nearest well...... ....................................Distance from nearest building................................... <br /> _.. er{ <br /> ❑ Distance to nearest lot line.._..._............................_..........__._.__........................._........................................._..._...... . <br /> Remodelingand/or -epairing (describe):......................................................................................................... .............................. <br /> .........._............._..................................... .................................................................................._...............:........_........._....._................... <br /> ..... <br /> ............................................................................................................................................................................................................................. <br /> ........................................................................................................................._---------------------------------- -..--------_------------_--. ............. <br /> I horeby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, end rules and regulations of the San Joaquin Local Health}District <br /> Ci0? t C A. <br /> (Signed).�. . .'!"�'b�'T'—..-9<' . _ (Owaas.+wd{ur Contractor)r� <br /> .... fie -.4si �-t <br /> (Plot plan, showing size of lot, location of system in relation +o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.S,..a-..... ... .- - ...... DATE .. ....._................................... <br /> REVIEWED BY.................................... ...................................................................................... DATE..... .. <br /> BUILDING PERMIT ISSUED---..'....._.... ............................................._........-...... DATE............ <br /> .............................................................. <br /> AHeraf:ons and/or recommendations:.....................4,.........................................................................4....................4......................... ....... <br /> ........................................................................................................................................................................._._....._.. <br /> ................................._.........................................................................................._....4.........._.....:................_......................................... <br /> ..................................................................................................................................................................... .................................................. <br /> . ...................................................................................................................................................................y................................ _1............ <br /> / _ <br /> FINAL INSPECTION BY:..........J4..� <br /> ......................................._ Daie._..._I ..�:. <br /> .._. ..... .............._............,......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Shoot 300 Wrat Osk St...f 132 Sycuner• SfrW 814 North "C"Sfrwf <br /> Stocktae, Glifomis Tr..y, C.ifomi. <br /> ES-9-2M C,12 R•v;,.d W-2100 <br />