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` APPLICATION FOR SANITATION PERMIT Permit No, -.3 <br /> (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 in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---------------/-�,/,---• •. 0--= <br /> Owner's Name----------- ----- � ''.�kt --------------------------- Phone--- ---------- ------------------- <br /> Address------------ <br /> -------•-----•--- <br /> Address-------•--••.................... r ---- - <br /> Contractor's Name - -- ----.-•---•--------------------- -----------------------•------------ ------ Phone----------------------------------- <br /> Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] <br /> Number of living units: .-/_-_- Number­df-bedrooms .Number of baths -_/__ Lot size .------_____________________________________________________ <br />*- Water Supply: Public system Communitylsystem ❑ Private F] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑; Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe n__Eazdpan ❑ <br /> Previous Application Made: Yes ❑ No �New Construction: Yes [g—No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if;public sewer is available within 200 feet.) <br /> I .. <br /> Septic Tank: Distance from nearest well;✓��-~Distance from found�ion__.__�l� lrilaterial_.._ __-__________________ __________________ <br /> No. of corn artments..._-'�_ Size____.._- 5 q d Capacity___ ____.__ IN <br /> P Li uid deh ��- -- <br /> Disposal Field: Distance from nearest we€l_!W"- Distance from foundation______ _- _.Distance to nearest lot line__._. <br /> Number of lines___._____ --------- ________ ---Length of each line_______17 ____-Width of trench.__. <br /> 9 <br /> T e of filter material�c_ ___ �j <br /> yp Depth of filter material ---- �-----Total length-------.-/�-----------••------------ <br /> Seepage Pit: Distance to nearest well------_--------------- <br /> Distance from found'atio;------------------Distance to nearest lot <br /> C ❑ _ <br /> line___-__-________ <br /> Number of pits_____________________Lining material______.___.__. - - Size: Diameter Depth <br /> esspool: <br /> - <br /> Distance from nearest well-----------------Distance from foundation---.---------------Lining material----------_------ ----._.____.______- <br /> 71 <br /> ❑ Size: Diameter----------------------------- --------Depth----------------` ------- T--- - ----Liquid Capacity-------- -------gals. <br /> Privy: Distance from nearest well.------------------------------------------------Distance from nearest building__.___.._________.___._________________--. <br /> ❑ Distance to nearest lot line---------------------- -------------- -s-------------------- r <br /> Remodeling and/or repairing describe. ....L,4 ____._ _ 44 <br /> - <br /> I <br /> 77_� ! ------ <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 bistrict. <br /> i j <br /> (Signed" \-----------•--------•---•---- ---------------------- -----------------------------------(Owner and/or Contractor) 1 <br /> By:--------------------------------------------------------------------------------------------------------------------------- ' = -(Title)---------------------------------------------- ------- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,7�an be placed on reverse side). <br /> ! : a <br /> FOR DEPARTMENT USE ONLY t <br /> APPLICATION ACCEPTED BY----------------------- ------------------- ---------------------------------------- DATE.----- r <br /> REVIEWEDBY------------------------------------------------------------------------------ ---------------- ----------------------------- DATE'----I-----------------------------------•--------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------•----------- -------------------------------------------- DATE------------------------------------- ------ <br /> Alterations and/or recommendations:---------------------- -------------- - -----------•-----------------------------------------------•--------------------------------•----------------------- i <br /> --------------------------------•--------------------------•---------------------------------------------------------------------..---------------------------------------------------•-•-------------------------------- <br /> I <br /> ------------------•-----------------------------------------------•- --------------------------------------------------------------------•-------- '--------------------------------------------------------------------•--- <br /> -----•----•-----------•------------• ------------ ----- ---------------- ---------•----------------------------------------------------------- --------------•------------------------ --------------•------------------• <br /> ----------------------------------------------------------------------•---- ------------ ------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY: Date-- oiv <br /> - ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _. <br /> '30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> \Stockton, California Lodi, California Manteca, California Tracy, California e <br /> 1M 10-52 Revised W-2100 <br />