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7 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ----- '...... <br /> (Complete in Duplicaft) <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health Disfrictfor construct and install the work herein described. <br /> �,a <br /> This application is made in compliance with County Ordinance ) permit to constr <br /> -------- ------ <br /> JOB ADDRESS AND.� CATION_ ---0------------(-------------- --------------­---------------C - ---------------------- -------------------_---- <br /> Owner's Name---------4��_ ........ _- --- ----------------------------------------------------------------------- ---. Phon --------- <br /> ------------ <br /> ---------- ------------------- - <br /> Address------C��7/......15---- ------- -- -----------�4 -------------- ----------------------------------------------------- m - - --------- --------- <br /> Contractor's Name__.---- - ---- N----—-------- hone <br /> ---- ----------------- ------ ----------------------- P <br /> Apartment House [] Commercial 'Ej Trailer. Court E] Motel ❑ Other <br /> Installation will serve: Residencqu,", <br /> nifs- Number of bedrooms c;,-�Number of bat , __17 __Iel Lof7 <br /> "e ----------.......... <br /> Number of living u <br /> Water Supply; Public em Community.system E] Private F-1 'Depth tc, Wafer Table. ft. <br /> t IV j . "` P <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel E] Sandy Loam [I Clay Loam Ej Clay E] AdobeX Hardpan 0 <br /> ' ' . 1'7 <br /> Previous Application Made: Yes El No )d New Construction: Yes Ej NoX FHA!/VA:'Yes ❑ Noo <br /> TYPE:OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> 9S pfi -ank- Distance from nearest well-----------------Distance from foundafion------------------�_.Materiai------------------------------------------------- <br /> No. of compartments------------ -- :--Size----------------------I---------Liquid depth---------------- ---------Capacity----------------------- <br /> p sal <br /> ep.th---------------- ---------Capacity----------------------- <br /> PXI F1 fd: Distance from nearest well..................Distance from foundation__.-____._-_ --_.Distance to nearest lot line___._________-___ <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench-----------------------------____-- <br /> - <br /> Type�(ii filter irn�feriai------------ Depth of filter material-------------- -.Total length________________-___-_______________ <br /> Pi <br /> Seepage f: Distance to'nearesf weliqm/U_&Disfance om f2unciation---1A---------Distance to nearesf-lc�f line_e__o----- <br /> Number of pits-.-.-Y--------------Linin,9 _-Size: Diameter__�_�_____� Depth------ ----------------- <br /> �Cesspook Disfan'ce from nearest well------------------Distance from foundation ----_-- - -----------Lining material-------------------------------------- <br /> El Size: Diameter-------- -------- -------------------Depth--------------------------------- - -----------Liquid Capacity-,. -------gals14 <br /> Privy: Distance from nearest.well----------------------------------------------11--Distance from nearest building_____._________________________--------.'.I <br /> ElDistance to nearest lot line- -------------------------------------------------------------------- -----------------------------------------­ ---------------------- <br /> Remodelingand/or repairing (describe]:------------------------- ----------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------4------------------------------------- <br /> ------------------------------------------------------------------1—---------------------—--------------------------------------------------------------------------------------------*11,----------I-------- <br /> --------------------------------------------------------w----------------------------I---------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared ibis application and-fhaf the work will be done in accordance with San. Joaquin County <br /> ordinances. Sta and rules and regulations of fhe,SanrJoa46in Local Health C�isfrict. <br /> -------------------- wrier and/or Contractor) <br /> BY:-------------------------------------------- ------(Tit <br /> (Signed)------------- ---—-—-------------- --------- --- ----- ------------ <br /> ---------------- <br /> w I � <br /> (Plot plan, showing size of lot, location of system in relationto w I s7-buildings, efc.,'can be- ,placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------------- <br /> APPLICATION ACCEPTED BY - <br /> ----- ---------------- ---- --------- --------------------------------------------------- ------- DATE---------------- <br /> - <br /> REVIEWED BY------------------------------- <br /> ----------------------------------------------------------- DATE----------- ---------------------------------------- <br /> BUILDING PERMIT ISSUED-------------- - <br /> ------------------ - - -----------------—-------------------------------------- DATE-------- _�!---------------------------------------------- <br /> Alterafions..and/or recommendations:,.----------------- -----------------------------•------- ------------- - --------------------------------- <br /> -—-------------------------- <br /> ------ ---------- 7_7 1-r- e!!�-----0-----------zp/_--;-------,4-T---------7-7 ---------------------- <br /> _e --/,-,- ---- -es- ------------------------------------------------------------------------------------- <br /> ---------- -ep,,=-------- Y------------- <br /> -----------------------------------------------------------------------------------­------------------------------------- -------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:--------- --------- 7-S <br /> -------- - -------------------------- Date. -- -- ------------f------------P,----------------------------------- <br /> 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 Revised 1,57 FP.CO. <br />