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APPLICATION FOR SANITATION PERMIT Permit No. .__. ..S•� <br /> (Complete in Duplicate) Date Issued ___�/V <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�542 <br /> ---------------------------------------------- <br /> JOB ADDRESS A D L C T N--------------------- ---- Phone <br /> si <br /> Owner's Name.--- ---- ---• - --------- ---------•---• ------------------------------ <br /> Address_.18._�+-e---------.. 9,%-d----- <br /> ' f e Phone. - <br /> Contractor's Name_____ --- •• -•---- <br /> - ----------------------------- <br /> Installation will serve: Residence 6-45 Ttment House ❑ Commercial ❑ Trailer Court [3Motel ❑ Other [I <br /> Number of living units: j---- Number of bedrooms o- Number of bathsl�_— Lot size __---- <br /> Communit s stem ❑ Private Depth to Water Table 7:--- ft. <br /> Water Supply: Public system ElY Y Cla Adobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y ❑ <br /> Previous Application Made: Yes ❑ )No <br /> ew Construction: Yes o-❑ <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 wel4_________________Distance from foundation__.____-____..._._-.Material-___-__.------- -----y----•-"-"------- <br /> No. of comparfiments Size--------------------------------Liquid depth--------------- ---------Ca acit <br /> I Distance <br /> pisposal Field: Distance from nearest well - "_--Distance <br /> h of each line ation.__._--- Width ofttrench est lot line---------- ---- <br /> Number o1 lines--_.__._- " - <br /> TYpe or filter material-------------------------Depth of filter material-----------------------To#al lengfih--------------------• <br /> .- > `r Depth__.-d <br /> Seepage Pit: Distance to nearest well ----- --Distance rom fo ndation-_A-0-_____.Distance to nearest lot line___ ____________ <br /> / �/ _-Size: Diameter_% <br /> �} Number of pits..----(--------------Lining material-_4.-- --:: <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- <br /> Liquid Capacify_ gals. �. <br /> q p Y----------------------- <br /> ❑ Size: Diameter------- ------------------------------Depth------------------------------------ ------ -- - -- -y <br /> Distance from nearest building---------------------------•------------- <br /> I Privy: Distance from nearest well____________ ___ - <br /> ------------- <br /> ❑ Distance to nearest lot line-----------------------------•---- <br /> ' Remodeling and/or repairing (describe): ----------------- - <br /> ----------------------------------------- <br /> - -:-•------------------•------------------------------------------------•-------------- <br /> I _----•---------------- <br /> ------------------------------- <br /> ------------I---. <br /> ---. <br /> -------- -------------------------I----------------- - <br /> -------------------------------- <br /> I <br /> ---•--------------------------- <br /> I herebcertify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances ytate laws, and rules and regulations of the San Joaquin Local Health District. <br /> ifor Contractor) } <br /> `' _ <br /> s (Signed) -- / ----------------------------(Title)- ---`��------`----- ---------------- <br /> By:--- <br /> ---- r� --------------------------------------- -.: <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 U-SE ONLY <br /> --- •------ -------------- �------------------------ DATE--- ------------------------ - -------- ---------- ----- <br /> ---- <br /> - ---- ------- <br /> APPLICATION ACCEPTED BY---------------------- DATE---.__ -- - ti.. <br /> REVII=WED BY_ <br /> ------------------------------------ DATE--------------- <br /> -------------------- <br /> ------------------------- - ------- --------------­... ----------------------------------------------------- ----- <br /> ---------- -- --------------------- ------- <br /> BUILDING PERMIT ISSUED-------------- ------ -- -,\ ------••-------- <br /> Alterations and/or-r-e--c--o--m---m---e--n--d--a-tions:--- --- ---------- - - <br /> --------------------------------- <br /> ----------- <br /> i ------------- <br /> --------------- <br /> ------------- <br /> ---- <br /> --------- - <br /> FINAL INSPECTION BY-=---- - - - --- -- -----•------•------ --------• <br /> Date--- �� -------- ---------------------- <br /> SAN <br /> ------------------•-SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _ 300 West Oak Street <br /> 132 Sycamore Street $14 North "C" Street <br /> ,130 South American Street Manteca, California Tracy, California <br /> Lodi, California <br /> Stockfon4California <br /> E5-9-2M 145446 ATWUOD 1a-54 <br />