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APPLICATION FOR SANITATION PERMIT Permit`7 a (Complete in Duplicate) <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 incompliance with County Ordinanc No. 549. <br /> �1 <br /> �.-- A5 ---�-�- --o��--------------- = <br /> JOS ADDRESS AND LOCATION-------------------�-�---�/'-�__-_____---____-- <br /> - .�2 --------� ` - �i��� n.� -- --------------------------------------- Phone �1 -X2_C? --------- <br /> Address <br /> -------- <br /> Owner s Name---------------------------=•-•-- - ----------� --- -- --�'7 <br /> Add ress-.-.----_--. =D­ ��,_, <br /> Contractor's Name--------------------------� -------------------- hone---J=�P ke-7------- <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I---- Number of bedrooms V- Number of baths Lot size _------------------ <br /> Water Supply: Public system ❑ Community system ❑ (Private Z� 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 ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se :ic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- <br /> Er—.''7fZ9 No. of compartments-- -Size--------------------------------Liquid depth-------- ---Capacity-----------------------� <br /> Disposal Field: Distance from nearest well-3�-4 -.-_.Distance from foundation__-__6__'_* <br /> ___-_---Distance to nearest lot line_,511 <br /> Number of lines__,/----------------------_-____Length of each line----- -----------Width offrench-----_` ----�`-------------___ <br /> Type of filter material__,"Ri ---- Depth of filter material________ --Total length-------�.�'-----__- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------_----------.Distance to nearest lot line----------------- <br /> El 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 /> 1 ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------------------------- ---------------------------------------- <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 ' <br /> ordinances, State laws, and1's and regulations of the Sari Joaquin Local Health District. <br /> (Signed)-------��_ �z"`° d' 1`- ---------------------------------------- (Owner and/or Contractor) <br /> BY = --------------------------------(Title) i� --------------------------- <br /> t <br /> (Plot plan, �howdng 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 --------------------------------------------------= <br /> REVIEWED BY ------------ DATE---- �.--`-----------------------•-------------•------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------- -�--------------------- r•-- <br />! Alt #i n an /Grecommen ations: -- -•--- a------ <br /> -------------------- <br /> --------------------------------------------------------------------------- <br /> - --------------------------------------------- ------------------------------------------ ----••----------------------------------------- <br /> FINAL INSPECTION BY: ± - _• Date--- --------------------------------------- <br /> I 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 B-51 Revised W-2100 <br />