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APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> (Complete in Duplicate( <br /> Date Issued ...... ...._7.'..... <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 County Ordinance No. 549 41 )&f s4- <br /> ' J B DDRESS AN LOCATION----- . ..- /,r... -4,10._1`� /' .. !1.��. ......- on --T} '--r7__ R( <br /> t � Y V - <br /> Owner's Name..... -- - - ti 1J_r .-11--..... .. .. �--......... . ..... Ph ........... <br /> �—� ..... .. --------------- <br /> Owner's Name. <br /> ... .........0_.........,... �....�..x.._ G ...._......._..--- -- <br /> �p,�� --�--- - - <br /> ContractorsName_....(Th?Y.3< PY-°'\.�..... ------------------------------------------------------ ....---------.......... Phone..........................--------- <br /> 'Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �1J <br /> ' Number of living units: a..... Number of bedrooms _ mber of baths .,{,e.. Lot size ......1............. ......_..........__ (N <br /> Water Supply: Public system ❑ Community system ❑ Privateepth to Water Table .___. ft. ilit O f <br /> ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ Nom New Construction: Yes�No ❑ -- —\ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ' (No septic tank or cesspool permitted if public sewer is available wifhin 200 feet.) <br /> Septic Tank: Distance from nearest well...45.�P------Distance from foueendation__Jb........ <br /> ........__Liquid depth.........No. of compartments...... ^ -------- _SCpaciy....jJj.a .... <br /> ' Disposal Field: Distance from nearest well....:7�....Distance from foundatioP../.Q..........Distance to nearest lot I"ne..�.......... e <br /> Number of lines......... _ ..__.�.,�Length of each line..._6-4.Y.4.-._.._Width of trench- <br /> 4, <br /> C <br /> U[,p r-..... <br /> Type of filter materia epth of filter material.... . ..:..........Total length.__.../. ... ......r}ss .-..... <br /> Seepage Pit: Distance to nearest well......................Distance from foundation...............----.Distance to nearest lot' line......_......_-..�❑ Number of pits.................._.-Lining material 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 loft. lliinne.... --------_.................. .. <br /> Remodeling and/or repairing (describe):..f...4trG. ...... .... ----•..r - l• <br /> --------- <br /> -- - --------------- ---- --------- --- - - -- - ---- -- -------------------------------------------------------------- <br /> - ..... <br /> ...... .................:... ---------------...-------------------------------------._..................................--• ...._........------......--------................................................... <br /> I hereby certify that I have prepared fhis applicafion and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, State <br /> laws, an rules and regulations of the San Joaquin Local Health District,' <br /> ' (Signed)..... <br /> .d✓..+. .:�''�.�-.I..... -.....................------ --- .................... .. .. -.........--(Owner and/or Contractor) <br /> By:......................................�........----------- ......--------.....----'-- . .................. ..(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 /> APPLICATION ACCEPTED BY........ ...............-------......_.. DATE... //.:REVIEWED BY............... ..... ----...... ...._...... ------............-•----............. DATE-------�-2 "..... -- --- -- <br /> BUILDING PERMIT ISSUED........ -' - - DATE.----..... . - � - <br /> -lAltera+ions and/or recommendations:....._..__. •�- <br /> .... -- <br /> ------.............. ...........-.............-•------........... -- ......•................--...__•. ............----....._........•......----.....-......-.........------------............-----.... <br /> ............--- .................. ........---- .... --- ......._................. . __...................---I. ........................­.................... . ...........--------- <br /> ----.......--------..............--------._......-- ... - - ............._.. - - - .. ..... <br /> - ----.--.--.--.- <br /> -- - ....._... <br /> FINAL INSPECTION BY:............. .. _... Date..... ...... ......... . <br /> ' f " <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C"Sheet <br /> ' t - Stockton,California Lodi, California Manteca, California Tracy, California <br />