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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued '�3 <br /> X5c)d: �7 <br /> f <br /> App)claf ion is hereby made to the San Joaquin Local Health District for a perminj <br /> to oonstrucf and iristall the work herein described. <br /> This application is made in compliance with County 0 dinance No. 549. <br /> !J�77r�_'-,& <br /> JOB ADDRESS AND -_OCATION... .... -- ----- - - ---------- --- <br /> -- <br /> ---- ---- <br /> Owner's Name 1___71_v--------- z. <br /> -- - --------- ----- --- ----------------------------- =Phone---- <br /> 77r. <br /> Address.. <br /> -1----------- ---------­--- -------------------------------------------------------------------- <br /> Contractor's Name-------------------------------- ---- --- - -----z- -----------------------------------------Phone----3? - <br /> ----------- ---------------------------- <br /> Installation will serve: Residence Apartment House ❑ ornmercial ❑ Trailer Court-[] Motel'L] Other E] <br /> Number of living units: __-I___--- Number of bedrooms Number of baths Lot size ------ a <br /> Water Supply: Public system D Community system F-1 Private Depth to Water Table�4?ft. <br /> -Character of soil to a dep+h-of 3 fee+: Sand E] ' Gravel E] Sandy Loam [] Clay Loam E3 Clay [I Adobp,'W' Hardpan E] <br /> Previous Application Made: Yes [-] No Now Construction: Yes El ' N C19 <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- ---- --------Distance from foundaPon-----eMaterial--- <br /> -7- ---- -- ------------ <br /> - ---(- ---------- <br /> No'..of-compartmonfs-----*2---------- -----Size-Z,_! ---Liquid <br /> 7 Ca -- <br /> pacity-------- ---e9--C17 <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------._.-bistance to nearest lot line----------------- <br /> -lyeNumber of lines-----------------------------------Length of each line------------------------------Width of french <br /> Type of filter material-------------------------Depth of filter material- ------------------Total length----------------- <br /> -------------`-- <br /> --------- <br /> Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line --------- <br /> Number of pits----------------------Lining material----------- <br /> ------------Size: Diameter------------- --------Depth_._..--- ------------------ <br /> esspo'ol: Distance from nearest well_________________Distance from foundation------------------.1ining material-__________.___________--________--_-. <br /> ❑ <br /> aferW-------------------------------------- <br /> El Size. Diameter--------------------------------------DepthL---------------------------------------------------Liquid Capacity-------------------------=.gals. <br /> Privy: Distance from nearest well,------------------------------------------------Distance from nearest building.-_______--- ----------------------------- <br /> 0 Distance to nearest lot line__---._ —---------------- <br /> Remodeling and/or repairing (describe):---_,,-Z <br /> mz�-------------------------- ------------------------------------------------ <br /> ---------------- ---------­--------------•---.-------------------- ------- ---------------------------------------- -I-/_-------------------------------------------------------------------------------------- <br /> -------------------------------I------------------------:----------------------------::--------------------------------------;��------------------------------------------------------------------------------------------ <br /> -- -----------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------- ---------------------------------------- <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,•.and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------ ft ---------- ------- <br /> ---------------------------------------------------------------------------------------------e�----(Owner and/or (3pt for) <br /> tractor) <br /> By:...------------------ --------------- <br /> ------------------------------------------------- ---------------------- <br /> ?e.of lot, caf6 of system in relation to wells, buildings, etc., can be placed(Plot plan, showing 6 1�1 d on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> - -- -------------------------I-------------- <br /> APPLICATION ACCEPTED BY----------------------------•-------------- UDATE.6 <br /> REVIEWED BY----------------------------------- - ,:; <br /> ------- ------------------------------------------------- DATE --------/� <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------- <br /> Alterations and/or recommendations:-------------------------------------------------------------- <br /> ------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- ------------------- ---------------------------------------- -------------------------------------- -------------­-----------­­------------------------------------I-------------- <br /> ------------------------------------------------------------------------------------------ ---------------------------------------------------------------- ------------------------------------------------------------------ <br /> --------------- <br /> ------------ ------------------------------- -------------- ----------------­-----------*------------------------:------------------------------------------ ----------------------------------- ------------- <br /> FINAL INSPECTION 'BY,,0060 ---- Date___7x <br /> ---------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />