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r Permit No. <br /> F. <br /> APPLICATION,,FOR SANITATION PERMIT <br /> (Complete in Duplicate) DateIssued.1- <br /> � -�-- --� <br /> d. <br /> rThis <br /> pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe application is made-in compliance with County O 'snance <br /> ------------------------------------------------------ <br /> JOB <br /> -- ------------JOB ADDRESS AL ATIO _--- . - - - <br /> Phone------------•---•----------- <br /> Owner's Name --------- - ------------- <br /> Address-----cD-------- - - ------ •- - <br /> ----------------•---------------- <br /> Contractor's Name -------- ----- <br /> ------�- -------•-�--•--- one---------------------------------• <br /> Installation will serve: Residence Apartment House ❑ <br /> CoG--mmercial ❑ Trailer Court-❑ Mofel ❑ Other ❑ <br /> L <br /> -- Lot size --- n/ ------------------------- <br /> Number <br /> --------------- ----- <br /> Number of living units: ___ <br /> "" umber of bedrooms ----!_-" Number of baths _ -- �J t <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Wafter Table - f# Adobe 2/Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Lo;�/N, <br /> Cla Loam Clay ❑ <br /> Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ �; <br /> Pp <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted ifubli� sewer i available within 200 feet. I , <br /> Materia _ ---- -------- <br /> _______ Is#an fro un on_ -1______-_---- <br /> j <br /> Distance from nearest wel__ _ / `� o Ca acit <br /> Septic ank: _Liquid e th:__-----".-"-- --- p Y t <br /> �__)k q P. ;.. <br /> No. of compartments__________ _ 1 `size_t F <br /> Dispos Field: Distance from nearest wellCll- --_-- <br /> istance from foundati nistance to nearest lot lin _ <br /> Number of lines---------- - ---Z. -- ----- ""Length of each line---��._`��rQ------Width of trench--------.�-�-I--- <br /> r er material___.__1.g `----=-Total length________-_�-,--� <br /> "----------------- <br /> Type or filter mater _ _t_ T -DEpth of filter <br /> Seepage Pit: Distance to nearest well_.-__f:-:-�_---'_-D;stance from foundation______-_"_..__....Dis#ance...D, - line________________ <br /> Linin material Size:IDiameter----•-------- Depth <br /> 171 Number of pits----------------------- g - j :d <br /> k _. <br /> Cesspool: Distance from nearest wel-----------------Distance,from foundation4_._.e�z_'____:Lining materia _______________-.--------------- <br /> ' _.De th"-"""". ��. Liquid-Capacity--- - ------------------gals. <br /> ❑ Size: Diameter'r-'-"""":--------= - p <br /> __.- n <br /> --_Distance from nearest buildig_____--___._;__--""______-_._.----.-- <br /> Privy: Distance from nearest well----------------------------------- ----- _ -'- - <br /> ❑ Distan --------------------- <br /> nce to nearest lot ine------------------------------ --k ----- ------- ------ <br /> _ ---- -- ----_-. <br /> -------------'" <br /> ----------------------------- <br /> ,1 .. - € <br /> --------------- <br /> Remodeling and/or repairing (describe):-- ---------------------------------- <br /> 1 ----------------- ---------- <br /> --•--------.. <br /> ________ ____________________________ r A <br /> ---------------------_------------------------_ _ <br /> I hereby certify that•1•have prepared this application and that the work will be done in accordance-with SanJoaquin County <br /> ordinances, State laws;and rules and regulations of the San Joaquin Local Health District. <br /> ' J - <br /> -----------------------------------(Own <br /> (owner and/or Contractor) <br /> (Signed)-- <br /> t -------- ----- ---- <br /> ------------ ----- <br /> :(T(Title)------------------------ <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 /> IDATE_ -- --------M1-- --- --------------------------------- <br /> APPLICATION ACCEPTED BY-- --------------------------------------- ---------------------------------------- <br /> I s <br /> DATE <br /> REVIEWED BY - ---- �•---- <br /> 1 I-------- DATE------------V---------------------------------- ----------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------- <br /> I ----------------------------------- --------------------------------------- -------------------------------------- <br /> Alterations and/or recommendations:_-__: - --------------- ----­-------------------------------- <br /> ------------------------------ <br /> -- ---------------------------- ----------- . ."" .. .. ---------------- <br /> 3 <br /> �'' --------- - -- Date---- <br /> FINAL INSPECTION BY___________________:------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 130 South American S+rest Trac California <br /> Stockton, California <br /> Lodi, California Manteca, California Y. <br /> ES-9-2M I0-52 Revised W-2100 <br />