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.•� <br /> APPLICATION FOR SANITATION PERMIT Permit No.<6..... . <br /> (Complete in Duplicate) <br /> Date Issued ___ <br /> '! <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct andS 'all-APAI A'all-APIto ldescribed. <br /> This application is made in compliance with County CO�rdinan�cej No. 549. <br /> TI . <br /> JOB ADDRESS AND LC)CAN.--._,._.�--[./---�C ,�' <br /> Owner's Name----A,l-,--(-�---- ,Ir --------------------- - Phone------------------------------------ <br /> Address. ^� r f-/--- {•--- - -- -• ------------- .� <br /> - ---- ------------------------------------------------------------------------------------- -- ----- ----------------------- ------ <br /> Contractor s Name-._ _____ t <br /> Installation will serve: Residencertment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1--_ Number of bedrooms _- Number of baths .-/-_ Lot size _____ __...LS _`__.-..--__ <br /> Water Supply: Public system [��e nnunity system ❑ Private ❑ Depth to Water Table,�'� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam L❑ Clay ❑ Adobe6_.J:lardpan ❑ <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 /> Septi Tho Distance from nearest well-----------------Distance from foundation_.---__----------.Material----..-_---_._--_-.-.----__.---------._-----_._-. <br /> No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------- --------- ---- <br /> ispo a� I Field: Distance from nearest well.44-- c---Distance from foundation-___-d__`_.Distance to nearest lot line._/6`------ <br /> Number of lines----------- - ---------- <br /> Length of each line------2-.�'-.-----------Width of trench-_---e j--------------_-_-.__ <br /> - <br /> Type of filter material. ...................._Depth of filter material-_.- ----------Total length------- _-_-_-__-_-._-_...__-- <br /> Seepa e Pit: Distance to nearest well-------------------...Distance from foundation-_---_-__-__-_----.Distance to nearest lot line----------------- o <br /> Number of p;fs----------------------Lining material_.---------------------Size: Diameter-----------------------Depth--------------------------------- "U <br /> esspool: Distance from nearest well-------------- from foundation--------------------Lining material_-_.-_---_-----------_------.--_--- (� <br /> ❑ Size: Diameter--------- -----------------------------Depth--------------------------------- ------- --- ------Liquid Capacity----------------------------gals. \f j <br /> Privy: Distance from rearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------------------------------------------------•----------------•-----------------------------------------------------------------------: . <br /> Remodeling and/or repairing (describe)___ __ _ _ _______________ __ <br /> --- <br /> ......-•--•-------•------t - -------------- ---z ---------------------------- <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, and rules and regulations of the San Joaquin Local Health District. <br /> r <br /> (Signed) lam__ Ow a dor Co racfor <br /> -[Titre] \ <br /> �C--------------------- --------------------------- g <br /> ---------- <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----- --- <br /> --------------- <br /> REVIEWED BY - DAT ------------------------------------------ <br /> �UILDING PERMIT ISSUED DATE -------------------------------------- <br /> eraflonS and/or recommendations:------------------------ - ------------------- ----------- -----------------•-------- <br /> -------------------------------------­­ <br /> -- -------- ---- ------------------- --------•----- ------- -----------..-------------------------------------------------------- --------- -•-------- - ------•---------- <br /> FINAL INSPECTION BY:--- --- -- -------------------------- Date..- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-v-2M 145446 ATWOOO 12.54 <br />