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----•-- _ --- Aft <br /> T f <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...� _ 7 <br /> - - """""" (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued <br /> - - - Date Issued ..... <br /> Application is hereby madeto-the San Joaquin Local Health District for a permit to construct and install the work herein descrbed: <br /> This application is made in compliance with County Ordinance Na. <br /> JOB ADDRESS AND LOCATION, <br /> a? <br /> F clso......... <br /> __fes. .. <br /> fes,.------------ -..:-. <br /> Owners Name.__.-------•---------- - --•-----4m..................... <br /> �d- ..._a_�_ <br /> Address---••-. ,: / Phone <br /> .. <br /> . <br /> ................................................................................ <br /> Contractor's Name---------------: ---•a cs Qom_ <br /> s - ------------------- •-----• ---...__. Phone...... <br /> c <br /> Installation will serve: Residence �partment House ❑ Commercial <br /> ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living unitsNumber of.bedrooms �_ Number of baths _/--_- Lot size _,<Q <br /> Water Supply: Public system ? /, -.o.."-•--•............-"....... <br /> Community system ❑ Private ❑ Depth to Water Tables-1-51-"ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ -Clay Adobe Hardpan❑ <br /> E <br /> Previous Application Made:'.11f yes,date___________________) IN New Construction: YesNo <br /> TYPE OF INSTALLATION-AND SPECIFICATIONS: ❑ CFFfA/VA: Yes ❑ No <br /> (No septic tank or cestpool permitted if public sewer is available within 200 feet.) <br /> Septic Tank:P Distance from nearest well_________________Distance from foundation---------------- <br /> --_.►vlaterial_..__..__._.__...__:..__ <br /> ❑ No. of compartments--------------------------Size.......---------------_----Liquid depth.. <br /> Disposal ld: Distance from nearest well-- -------------Capacity....._:..._.___.:.:.:._ <br /> �.r-�"_Distance from foundation ._ --f..---..Distance to nearest lot line-�_/._--•-_- <br /> Number: of lines------------- ------- ----- - ---Length of each line-__ ---- � <br /> � <br /> Type of filter material-------� material--. ll Width n tren....3 l -------•- <br /> -(?-��____Depth of filter - .--•. � <br /> j , Tota( length ------••"----"-....... <br /> Seepage if: Distance to nearest well____--'�---------Distance from foundation___- -0____..__-.Distance to nearest lot line----- <br /> Number Number of Pits-------I------------Lining materialYD C .-- <br /> Size: piameter.__Z�,_./ t L` <br /> `" -----Depth---c�,,;,�----•--•------------ <br /> sspool: Distance from nearest well________________•Distance from foundation--------------------Lining material-,------- <br /> El Size: Diameter--------------------------------------Depth-------- -------- - --- <br /> Liquid Capacity <br /> Priv = 9 •------•--------••--------•-gals. - <br /> ❑Y: Distance .fr•om nearest well-------------------------------------------------Distance from nearest building._.._._.._...______.._:.__.-.. <br /> Distance to nearest lot line__________ ___________ <br /> ----------------------- --- <br /> r � ___________---------------------------------- <br /> Remodeling and/or repairing:(describe:-•"--------•----- <br /> ---------------------------=-- fir/ t <br /> % <br /> s. .......................___ _­..�� a <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, les and re ion f the, an Joaquin Local Health District. <br /> (Signed)--------_ <br /> wner and/or ntractor) <br /> t --•- -- • ------ ---- Mile).......... -• <br /> {Plot plan, showing size of locatio of system in relation to wells, buil t <br /> c., can be laced on reverse side). <br /> i` I FOR DEPARTMENT I.ISE ONLY- <br /> APPLICATION ACCEPTED'BY�1_ _ _� <br /> ....�-�----------- <br /> REVIEWED BY--------------------•-�-=- -1--- 5 -- - • .. <br /> DATE_........................................................... <br /> BUILDING PERMIT ISSUED:-�---��----------------------"�.,-._.._ _ ., .._ •, ._:_._..___. __ -- - <br /> _ <br /> D <br /> AFterations end/or recommendatio s:---/ZI� �7 DATE----------- <br /> -------------------------------------------- <br /> :> <br /> 0- <br /> ----------------------------- <br /> -- ------------------------- <br /> ----------------------------------------------------- <br /> -------------------------------- <br /> FINAL INSPECTION <br /> = Date---/ .�._. _..' ..1 <br /> SAN J AQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut r 300 Weat Oak Street <br /> Stockton,California �' 124 Sycamorf-Stree+ 203 West 9th Street <br /> �'; Lodi,CaliFornia <br /> Manteca,Caitfornla Tracy,California <br /> ES 9 REVISED 8-09 IM 8-61 ATLAS : t <br /> !1 r <br />