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l�yLICATION FOR SANITATION PERMIT Permit No. _.. .............. <br /> (Complete in Duplicate) / <br /> Date Issued <br /> f Applica+-ion is hereby made to the San Joaquin Local Health District for a p r it to con truct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549.0 ��•e a <br /> f 051 <br /> S -t=�Al <br /> D c <br /> JOB ADDRESS AND \C �1''lJ --�-n-en-----------I------ ----------------------------f-..fJ 5------�'' a <br /> Owner'�s Nam--e� -- -l�-a .� uc��- {�+ ` �n/ h 1__ #----------------- Phone------------------------------------ <br /> Address__�.Q�.x►---�^-��UN.12t_ �,i�----- - ���"-----`- -----------•----��----~------- - 1- <br /> .J1l4_#.-1`1--�i-H---------!- _ ------------------------------------------ Phone-:A0---.X.7.0.5 6--- <br /> ------------ <br /> Contractor's Name------ .__ 7r <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other <br /> Number of living units: _;�=unity <br /> er of bedrooms' -. Number of baths _..__ Lot size -----�_�,u,.____P------'S__.___I__,__-__-___ <br /> Water Supply: Public system y system ❑ Private ❑ Depth to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe j?r"'Hardpan E]Previous Application Made: Yes [:] No ew Construction: Yes e No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public wer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well____ _ Distance from foundation___ <br /> _______�at v_i_al___ _________--- _-..-__-______- <br /> No. of compartments--_2_________________Size Liquid depth7_� ...._.______Capc1 <br /> « ,f <br /> Disposal Field: Distance from nearest well_0497A-_._Distance from foundation___— -_ Distance to nearest lot line______ <br /> Number or lines______ ____ Len th of each line__ Width of trench__�s__.g---------------------- <br /> Type <br /> ____-. . <br /> {{ g �, <br /> Type of filter material4... ... --Depth of filter material----�- _ _---------Total length---�d---------------------- (� <br /> Seepage Pit: Distance to nearest well------------------_---Distance from foundation____-_---_•_--____-.Distance to nearest lot line__.-__-___-_.____ <br /> ❑ Number of pits---------------------_Lining material-----------------------Size: Diameter----------.__.---------Depth--___-____--_.---_--__________-_- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material_______._._-________--•_..--__._____- <br /> ❑ Size: Diameter--------------------------•-----------Depth----------------•-----------------------------------Liquid Capacity----------------------------gals <br /> Privy: Distance from nearest well---------------------------------- . __---__Distance from nearest building----------------------------------._.__-_ <br /> ❑ Distance to nearest lot line--------- ------------------ _ ----------------------- ------ _ ----------------------------------•-------------- r—(\ <br /> Remodeling and/or repairing (describe)- ---c=� ---•---------------------------------------•---------•----••----•C <br /> -----------------•------ -------- .-- ......--- <br /> : :_ : ---I `i----------�z2-�j --�los-1-------------------------------------------------------- <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 J quin Local H alth District. a <br /> (Signed) <br /> .......................................................... <br /> -------------------------------------------------- - --- .. <br /> P <br /> .. ----•--- -a {mac Contractor) <br /> By:-------------------------------------------------------------------------------------- -- -- -- ----•----- -----_(Title)- ---- - --- --------------------------- <br /> (Plot plan, showing size of lot, location of system in relation welings, et , can be p aced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- DATE.......................... --------------------------------- <br /> .�q. - <br /> REVIEWED BY------------------------------------ - - <br /> ------------------------------------------ ------------------------------- -- -- - DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------- - -- - --- ------------------------•----------------- ------. ................................................................................ <br /> ----------------------------------------------------------------------------------- ------ ------- ------- ------------------------------------------------------------------------------------------------------- <br /> -------------- ------ - --------------------------------------------------- - -------------------------- ---------------------------------------------v-``--- <br /> ------------------ <br /> -------------------------- <br /> ------------------ <br /> FINAL INSPECTION Date. • --•- - <br /> SAN <br /> 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 />