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06, <br /> APPLICATION FOR SANITATION PERMIT Permit No ------- <br /> (Complete in Duplicate) <br /> Date Issued <br /> a <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County,01dinance o. RA 9. <br /> JOB ADDRESS A LOCAT N..___ _ ___ __ <br /> ------------ ---------------------------------------------- -•- <br /> Owner's Name---- t-------------- ------------------------------------------------- Phone___- _ -C. <br /> Address----�� Cr • -- ----- ---- ---------•-- ---------------------------•-----•------------------------------------------------------------------------------------------------- <br /> Contractor's Name--- ---------------------- --- ----------------------------------------------- Phone <br /> ---------------0---------------- <br /> Installation will serve: Residence Apartment House rr�� Commercial Trailer Court Motel Other' <br /> Number of living units: ___I__ umber of bedrooms _2— Number of baths __1___ Lot size c�__r _- - - -�_____________________----_ <br /> Water Supply: Public system [Community system ❑ Private 0 Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No /-New Construction: Yes ;No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public ;ower is available within 200 feet.) <br /> .II <br />.' Septic ank: Distance from nearest well__ _ _ Dista cb fro found9fion____(-__ _______.Mater I�____________________________ _ ______-_. <br /> No. of compartments--------- - ------r�-----Size�__� ,��----Liquid depth------____-- -------------Capacity Dispos "I Field: Distance from nearest we ____ _. -- Distance from foundatio ___ -1-..___�Di�t� ,to nearest lot line_____-____- <br /> << <br /> Number of lines____ __ ________________ _____Length of each line-5-0" --1 --t_1.�-.�Vt/�d of trench-_____��_____-P___F________ <br /> Type of filter materia ___ _ --_---Depth of filter material___1_Q_____________Total length____-__---' ____:=_ <br /> . <br /> Seepage Pit: Distance to,rieareg# well.___ <br /> ----------------Distance from foundation---------------------Distance to nearest lot line____________.___- <br /> ❑ Number of pits----------------- ---Lining material-----------------------Size: Diameter------------------------Depth----------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material-------------------------------------- <br /> Its <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- <br /> ❑ Distance to nearest lot line----------------------------------------------------------------•--- ------------------•--------•----------------------•---•------------•--- <br /> k R od andYor re,airing (d.scribe]: .� --------------­--•---------- <br /> ----- <br /> ------------- <br /> --- --------------------•-------•--------- <br /> --- - ----------- <br /> ... ---- --- ------ ---- ---- ::. <br /> •---••---------------• --._...----------------------------- --------(j V ---------------------.....................- -----------. ------------ <br /> -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> hereby certify that I have prepared s application and that the work will be done in accordance with San Joaquin County. <br /> ordinances, S t aws, a rules and r tions of t n Joaquin Local Health District. <br /> ---------------------------------------------------(Owner and/or Contractor) <br /> k <br /> (Signed)------ ---------- --- ---- <br /> By---------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------- ------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> i� <br /> FOR DEP RTMENT USE O LY <br /> i APPLICATION ACCEPTED BY---.---,- --=- ------t------- ` DATE-------� �"--•------ <br /> 1 REVIEWED BY------------- --------------------- - -------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------- t-1------------------------------- DATE----------------------- '--r-------------=----------------- <br /> Alterations and/or recommendations: f j# --------•----t-`------- ---------A A---------•-•-----------------------------------•----------- <br /> -M1- ---- e'# ' ''-"-----------}r-- _ - *_��- ---'' -,1"----------- = b <br /> ---- . t <br /> � � 2.. t A C-1-1 --- ---------- ---------- ---�__...-- ------ --------------------------------- <br /> ------------ ----y-•-_ ------. -. y �y <br /> ----------------- ---- <br /> � �s "z---- w 2 ---- `� = :- - <br /> � i� <br /> l FINAL INSPECTION BY:-------`� Date -7-- ._- --�f - <br /> ' SAN 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 8-51 Revised W-2100 -- <br />