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APPLICATION FOR SANITATION PERMIT Permit No. ---I--- <br /> (Complete in Duplicate) <br /> .. _ �u �. -. _ Issue <br /> Date d <br /> Applica+ion is hereby made:to the San Joaquin Local Hsalth District fore permit to construct and install the work herein described.+ <br /> This application is made in compliance with County Ordinance No. 549. , <br /> Q f Q� <br /> JOB ADDRESS AND LOCATION_._' .J------s ._' D IQ_ e!...--' --------o +t_,_C_, 7l-----.'---------------------------------------- <br /> Owner s Name_ _' Phone "' <br /> _..r _.. - ------ <br /> it <br /> ' d_:a.. rr� ----- -----------------:-'----------------------------------------------------------------- -------------------------------------- . <br /> Address---------_--••-- ---------- r s ��,, ` <br /> Contractors Name iC ---------------------- ------ Phone"IIQ <br /> T-------------------------- - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of linin units: _ -Number of baths __. __ Lot size --- __ .. <br /> lining .units: Number of bedrooms __ <br /> Water Supply: ,Public:"system-'' Community systemµ❑ Private ❑. "Depth to Water Table _ Oft. <br /> Character of soil to a de th of 3 feet: 'Sand Gravel y ❑ y ❑ y ❑ Aclobeio Hardpan ❑ <br /> p ❑ ❑ Sand Loam Clay Loam Clay <br /> Previous Application Made: Yes ❑ No )( New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic fanVo pool permitted if public sewer is available within 200 feet.) <br /> A <br /> ic Distance from nearest well-----------------Distance from foundation-------------------- l <br /> Materia _________-__.__._.-________... ------- <br /> No. of compartments--------------------------Size-__..-•-------------___ <br /> I t Liquid depth Capacity W <br /> Dis as I id c Distance from-nearest welf---______---------Distance. from foundation---------------w.-----Distance to nearest lot line•---___-.---_---- a <br /> NuFmber of lines------ .-_---_.___'---------------=Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material-------------------------'Depth of filter material-----------------------Total length___-_-------___-----__--___-_--- <br /> Seee Pit: Distance to nearesf'well- 5Y°Distance- r ou dation ""' <br /> - - - ��.�_.. • tante to nearest I$� l�i+ne____�_r_+-� i <br /> Number of its.__ !, f <br /> P_ _- --------Lining material Size: Diameter_ ----------Depth--- <br /> WIS---•-------------- <br /> Cesspool• Distance from nearest well-- -------------Distance from foundation_---------------..'Lining material-----------------------___--__-_--_- <br /> ❑ Size: -Diameter ---- -t-----------------------------Depth-------------.----------------- - Liquid Capacity gals. i <br /> Privy: Distance from nearest well--__.. _I---Distance from nearest building.__- _____._.:_-- <br /> Distance to nearest lot line_ <br /> Remodeling and/or repairing (describe)___________________________ _' <br /> -----------------------------------•--------- <br /> '-------------------------------------------------•=-------•----•----------------•-`------=_ - <br /> --------------------------- -- ---- ---------------------------------------I...._ <br /> --------------------------------------------------- <br /> I hereby c tify at I have'prepared- .'s applicatio and that the work will,be Clone in.accordance with San Joaquin County <br /> ordinances, Stat aw and rules d regu ons of the. Joaquin Loca Health District.' <br /> (Signed). = -- ----- I Contractor) <br /> $Y� --------=----------- - . - ; :_ITitle}_43 - <br /> �[,e"� - ,o-=------------------- <br /> (Plot plan, showing'size of lot, location of syste in re i tb wells,`bui Ings, etc., can "be placed on reverse side). <br /> t <br /> "'FOR DEPARTMENT USE ONLY' <br /> 4 <br /> APPLICATION-'ACCEPTED.BY----------------------------- <br /> ------ -."`„ DATE —` <br /> --- <br /> REVIEWED BYJ-----------,----- ------------------------- _-z <br /> -------- DATE----- <br /> BUILDING PERMIT ISSUED = =-----------------------------'-------------------------=----------- _:_tet--------. DATE----- <br /> -------------------------------------------- <br /> I----------- <br /> ` # <br /> Alterations and/or.recommendations:=°= =` -¢-_•--•--------------------••-•-----------------------•-•----` ---------------­-------------------------------------- <br /> ---------- <br /> . _-------.-E_ <br /> _ _________________________:.-_.---___-__._______.._..._. <br /> i <br /> ------------------------------------------------------------------ i <br /> __________________________________________________ j <br /> t v{ <br /> ------------------------- - --- <br /> s <br /> FINAL INSPECTION-BY:._-- --------•-------- - •- • ---------• Date--'--------=-------• �-'--=--_--==------'- --'-------"-=------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfraef 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Sfockfon, California Lodi, California Manteca, California Tracy, California , <br /> ES-9-2M.; • Revised W-2100 '� <br />