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APPLICATION FOR SANITATION PERMIT Permit No ------------------- <br /> (Complete <br /> -` - <br /> (Complete in Duplicate) <br /> Date Issued k-;1__ <br /> s�r1'7�#� <br /> Application is hereby k 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 complia e with County Ordinance No. 549. <br /> JOB ADDRESS A LOCATION ' J 'f4 ` ��� -------------------- <br /> V <br /> Owners NamePhone <br /> ----- <br /> Address-••---...- ;--- ' f <br /> Phone_*---; O----- <br /> Installation <br /> - <br /> Contractor s Name----- -- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Mo el Other <br /> Number of living units: A3_ Number of bedrooms __�___ Number of aths J_ Lot sizelu4!-v__ ? " -"-.---- <br /> Water Supply: Public system ❑ Community system '❑ Private Depth t ater Table -------- ft. <br /> x <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam g Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [r E <br /> Previous Application Made: Yes ❑ No New Construction: Yes 0"'No ❑ <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_ 0____Distance,jr+aSm ound ion____1(f_____.Maier j-----------------------------__________ 1 <br /> p No. of compartmEnts---------- - ----------Size!__t1' ----x_ _x Liquid d lith---------�-----------Capacity----�-- -:1 <br /> Disposal Field: Distance from nearest w II__ I 0___Distance from foundation_ _ Distance to nearest lot Ii <br /> [ Number of lines___________ 1 Len A of each line----------j_ a _ Width of trench---- <br /> r--- <br /> ---- <br /> rench -- <br /> -� g t - j <br /> jType of filter materia ! Depth of filter material________ _ _____Total length________ __ a_- <br /> I - <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--------------------Lining material-------------------------------------- <br /> ❑ Size: Diameter--------------------------------------Depth_---------------------------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line-----------------------------------------------------------------------------------------------------------------------...-------------------- <br /> 1 <br /> Remodelingand/or repairing (describe):-------------------------------------- ------•---•--------------•----------------------------•-••------------------------•------------•-----------------• <br /> -------------------- <br /> --------------------------------------- ------------------------------------------­.............-1-----------------------------------------------------------------------•-•-----------------•-------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, to law;.i, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed ------ <br /> F - -- <br /> ---------------- - -------------------------------------------------------------------------(Owner and/or Contractor) .. <br /> Bye,P� ��� -----4`.. � -------------- -----------------------------------------(Title)---------------------------------------------------------------- <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 ----------------- --------------------- DATE <1 <br /> BUILDINGPERMIT ISSUED-------------------------------------------------- ------------------------------------------------- DATE---------- <br /> Alterations and/or recommendations--- -----------------------------------------------------------------------------------------------•----------.....----------•---- <br /> -------------------------------------------------------•--------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------••------------------------ -----------•-------------------------------------------P- ----------- ---------------------------------------------------------------- -------------------------------------- <br /> FINAL INSPECTION BY------------- Date :2-------------------------- ------- <br /> ---1:_._-- ------------ ---- ---- -- <br /> 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 8-51 Revised W-2100 <br />