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�A1 <br /> 1\ APPLICATION FOR SANITATION PERMIT Permit No. _�__s_�-�---+ <br /> (Complete in Duplicate) 5 <br /> Date Issued r <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 compliancewithCounty Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..___16_- Q r-� - l.., - ---------_------------- ------------ ----------------------------------------------------- <br /> Owner's <br /> ----- -- <br /> Owner's Name------ s .J ... ._.. ----------- -- ---- ------ Phone--------------------- <br /> Address------------- �..._ '�� -• G- .�- �` °'�- -- <br /> Contractor's Name----- <br /> ----------------�-----------------------------------------------•------------•----------. Phone <br /> Installation will serve: Residence 1--f Apartment House ❑` Commercial F1Trailer Court ElMotel E] Other ❑ <br /> Number of living units: __!_____ Number of bedrooms __Y--- Number of baths ___f____ Lot size __, _�___-- _----�•, -� <br /> ------------------•- <br /> Water Supply: Public system Community system ❑ Private ❑ 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'to ❑ <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 well�_t�Distance from foundation---4_6---------- <br /> _4_6----------MaterialJaL"a.__" - <br /> No. of compartments -----------Size---�.�I�- � ---Liquid depth-_.-:�—_______________Capacity__ Q- <br /> Dispos I Field: Distance from near st wel! __________ __Distance from foundation---- -D-----_....Distance to nearest lot line_,'___-. <br /> Number of lines-----_ en th of each line_-__� iQ-------------- -Width of trench-- <br /> Type of filter materia - of filter material---)-?`.........Total length-___1__�- �- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line_--__.______ <br /> ❑ Number of pits----------------------Lining material---------.------------ Size: Diameter---------------------- Depth-------------------------------_• <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material__..._ - <br /> ❑ Size: Diameter------------------------- ------------Depth------ ---------•------------- - -------------------Liquid Capacity_-------------------------- <br /> gals. O <br /> Privy: Distance from nearest well-------_-----------------------------------------Distance from nearest building <br /> ❑ Distance to nearest lot line----------- <br /> Remodeling and/or repairing (describe):-__ € ........ ------------------------------------ <br /> ----------- <br /> -----••-------------------••------------------ -------------------------------------------------------------------- <br /> - ---------------------------------------------- ------------------••------•-------------------------------•-------------•------------------------------------------------•-------------------•-------- -------------- <br /> I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations"o the San Joaquin Local Health District. <br /> {signed) ------------- ------ _•- --- -- ----- ---------- -----------------•---------------"------------------------------------(Owner and/or Contractor) <br /> By:---------------_-- - -- -----------------------.-------------------------------------••-----------------------(Title)------------------------------------------- -------------------- <br /> (Plot plan, showing size of lot, Iota ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------------- - ---------------- - -- ------------------------------------------------------ DATE-------- ,'�__------------------ <br /> REVIEWED BY -------------• DATE-------------- <br /> BUILDING PERMIT ISSUED------------------------------------- - --- --------------•------- ---------------------------•--- DATE......I....... <br /> - -- ----- �- ------------ -------- <br /> Alterations and/or recommendations:_- ------------------------- _.------------------------------.-_ <br /> Z. <br /> -------•--------------------- -•-------------------•-------•-----•---------------------- ------------------------------------------ <br /> -------------------------------------------------- <br /> -----------------------•----- -------------- ----------------------------------------------- ----------------------- ----•------------------•--------------------•-------------- <br /> ---------------------------- <br /> - ` <br /> FINAL INSPECTION BY:.- ---- --- ---------- Date- �CZ-S.4 Date----------------- ---------------------- <br /> SAN <br /> ---------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2M 145446 ATWnOb 1254 <br />