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APF--�ATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) o i <br /> Date Issued --------- <br /> Application 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 complian with County Ordinance No. S49. <br /> JOB ADDRESS AND LOCATION__ _q- --- <br /> .�� <br /> —Owner's Name. -------=----------------_------ ----_--- <br /> - Phone------------------------------ <br /> - <br /> Contractor's Name.----. 'l---- i : <br /> ------ = ---------------------?4 ��.. <br /> f --- Phone <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court p Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ___.____ Lot size ___i :x:_L �.. <br /> -�Water Supply: Public system ❑ Community system ❑ Private� Depth to Water Table , _�_ 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 ® New Construction: Yes,® No ❑ FHA/VA: Yes ❑ 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.,4_U_______Distance from foun ation__.__ ------Material_._�?.L'�__-__r.�____- <br /> No. of compartments_. -^z__ ___-_______Size.3.��12.-G�_v_------Liquid depth-----,_-/ yo'a <br /> Capacity--l <br /> ispostil Field: Distance from nearest well_.�_$7-'-"__...Distance from foundation-__- °_ _____Distance to nearest lot line__22:1c__ <br /> ® Number of lines------/-------------------------__Length of each line---6O---------------------Width of trench-_.2Y._____________-_______- <br /> " _-_ <br /> Type of filter material____"!,:r�____--Depth of filter material---le.._____.____Total length-----S' V' ' <br /> ---------- <br /> Seepage Pit: Distance to nearest well_:/!- Distance f rom fo ndation---�_�,----------Distance to nearest lot line__`- <br /> Humber of pits-__-_f_______________Lining materialL�!__.-_._ 3 . ' <br /> _ ._.--Size: Diamefier---='-'-=-'--------•---.Depth---'2..-`�_'_----•----•--------- <br /> Cesspool: Distance from nearest well_____•-___-___.__Distance from foundation--------------------Lining material____-___________________._____ <br /> ❑ Size: Diameter--------------------------------------Depth-------=----------------- ---_---Liquid Capacity ----------gals. Is\ <br /> Privy: Distance from nearest well___________________•_.---:________-.-------------Distance from nearest building____-.-.______.__-_-_._____________-__-_ <br /> ❑ Distance to nearest lot line------------- <br /> ------------ <br /> Remodeling and/or repairing (describe)___________________ _____________ __ <br /> ••--------•-------------------------------------- . <br /> — ---------------------------------------------- <br /> --------------------------------------------------------------------------------------------------- ----•----•---- <br /> ---- <br /> ---------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t <br /> ordinances, S to S. rules-and regulations of the San Joaquin Local Health District. <br /> ----�d L__ <br /> (Signed) fid - - (Owner and/or Contractor) <br /> gY------- -"!'`------------ -------- ----------------- ----- ----------------------------------------------(Title)-------------------------------------------------------------- <br /> (Plot \n <br /> plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side).411 \ �1 <br /> FOR DEPARTMENT USE ONLY tel) <br /> APPLICATION ACCEPTED ------------------------------------------------------- DATE--- - �'�7 <br /> -------- <br /> REVIEWED BY- ^------------------------------------------------------------------------------------- DATE <br /> ­31JILDING PERMIT ISSUED---------------------------------------------------------------------------------- ----------------- DATE <br /> Alterations and/or recommendations___________________________ - ----------------------------------- <br /> _______________________________________________________ <br /> --------------------------------------------------------- ----•-----•------------ ---------•-------------------------------------------- <br /> -------- ------ <br /> ----------- <br /> FINAL INSPECTION BY:.._ _ ..f ;�", ` � _,rrr______...... Datel-. _-�� <br /> {� - '--------------r------------------ <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-9-2M • • Revise❑ 1.r7 F P rn_ <br />