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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued _3_ <br /> l---1T-- <br /> Application is hereby made to the San Joaquin Local Health District for a perrriit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> b ' ^-f---------`e - •--- ----- <br /> JOS ADDRESS,AND LOCATION------------------------- ; <br /> Owner's Name .. Cz ` - Phone <br /> `ii <br /> t �1 ='` ' --------------------------------------------------------------------------------------•--------------•--------- <br /> Address-------------------------------- _ <br /> Contractor's Name---- o i u d �:2 -------------------------- Phone. <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motu❑ Other ❑ <br /> Number of living units: __'_.__- N er of bedrooms _�r Number of baths ........ Lot size _____� '6_,A___ ,� -�---- ------ <br /> Water Supply: Public system Community system ElPrivate.[:] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ QaTLoam ❑ 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 Ta Distance from nearest well----62-__f--_Distance from foundation--e---------- <br /> Material____-�'_�_-_-d_r/C-- -------- <br /> Lam' i <br /> No. of compartments------.-��-----•__--Size...--��--?�-�a__.___Liquid ---------Capacaty_____- a�J__-_- <br /> posal Distance from nearest well------ from foundation_-_ `- -� Distance to nearest lot line-S----------- <br /> 470 � -------- <br /> Dis Number of lines--------;--------------------------Length of each line--------�-Q- Width of trench---- -k--i----------------- <br /> Type of filter material_Y '4..1�.______Depth of filter material---- j-�_f!-_.-_Total length____________ __ ---------------------- <br /> Seepage Pi�. Distance to nearest well_------0---------Distance from foundation-_-.f0___-___.Distance to nearest lot line-___._.___._____ <br /> ®/ 3- <br /> Number of pits material-- -n_ -*��.---Size: Diameter- ------ ---------Depth---i;kl----------------- S\ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--------.-------------------------- <br /> __ <br /> ❑ Size: Diameter--------------------------- ----------Depth------- ---------------------------- --------------Liquid Capacity-------------------- gals. <br /> Privy: Distance from nearest well------------ ------------------------------------Distance from nearest building---.------_---____-__-____---._--------_ <br /> ❑ Distance to nearest lot line------------------------------------------------------.--�-------------=---------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)- ---------------- -c ~' ' '--------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------•----------------------•----------------. <br /> --------------------------------------------------------=­-----------------------------------------I------------------------------------------------------------------------------------------------------------------------ <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 Joaquin Local Health District. <br /> (Signed) -------- --(Owner and/or Contractor] <br /> ----- <br /> By: -----------(T e) 7 <br /> (Title �'` <br /> (Plot plan, showing size 'lo't, location of system in.relation }o wells, b ifdings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BY----------- -----------`--------------------------------I---------------------------------------- DATE------- �� 1 J ---•----------------------- <br /> REVIEWEDBY------------------------------------- --=------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------•-•--------------------------------------- DATE-------------------=------------------- --------------------- <br /> Alterationsand/or recommendations.----------------- ----------------------------------- -----------------•--•-------------------- -------------------• --•-----•----•---------------------------- <br /> ---------•----------------•-• ---------•-•------------•-----.-.------------------------------------ -------------------------------------------------•-------•------------------------------•-------•--I--------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_------------------------------------- <br /> �./ ~ � 000, <br /> FINAL INSPECTION BY:. Date_ --------------- ---- ------------ ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M . Revisea 1-57 F.P.Co- <br />