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APPLICATION FOR SANITATION PERMIT Permit NoJ... <br /> (Complete in Duplicate) A=,I <br /> Date Issued 7=17_4_[-�3 <br /> �plicafion is hereby made to the San Joaquin Local Health District for a perm+f to construct and install the work herein described. <br /> This <br /> application is made in compli pnc with County Ordinance No. 549. <br /> �:16 � . <br /> JOB ADDRESS AND LOCATfON__a2 ----- - <br /> Owner's Name----- i.,%* <br /> ----------�&__ 244--•----------------------- ------------- <br /> -------------------- Phone <br /> Address-------V-1-A---y • <br /> ------------------------------------- -------------­---------- <br /> Contractor's Name------ -------------- -------------------------- Phone..4 <br /> Installation will serve: Residence [Apartment House [] Commercial El Trailer Court El Motel El Other <br /> Number of living units: _1---- Number of bedrooms _1---- Number of baths __/---- Lot size -—--------------------- <br /> Water Supply- Public system [I Community system El Private R��epth to Water Table .la'-'ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Ej Clay Loam E'] Hardpan: <br /> Previous Application Made: Yes E] No New Construction: Yes E] No Fg­ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Na septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank. Distance from nearest well_________________Distance from foundation---- _-_.----.--__-.Materiai <br /> No. of compartments--,---------- <br /> --------------------- <br /> -------------Size-------------------------------Liquid depth----------------------.-`Capacity------ -- ----------- <br /> Disposal Field: Distance from nearest weil_...d_0___ Distance from foundation- le----Distance to nearest lot line----41 <br /> lines---------..1. - -:: <br /> Number of ------- --- Length of -------- -Width of trench__4 <br /> -------------------------- <br /> Type of filter material.Jir----JI(A-_-Depth of filter material-----12_6--------Total length------ <br /> Seepage Pit: Distance to nearest well-----10-h_----Distance from foundation---__Itl 4 Distance to nearest Iot iine-----&0_!, <br /> Number of pits-------- -----------Lining maferiaI__&i-2ud-_wiAZ- <br /> I Size: Diamefer___.?__C._'........Depth------70---I---------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--___.--._--_.----___---_._--.--_---. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------- ------Liquid Capacity.. ------------------------gals. <br /> Privy: Distance from nearest well_____________________--------------------------------Dista from nearest building--------------------- ------------------- <br /> El Distance to nearest lot line----------------------------------- 111- <br /> ------------------------Zn___:---- -------------------- <br /> ---------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------- ----------- <br /> Remodeling and/or repairing (describe):___-_-_____-___---_._ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------­----------_------------------- ------------------------------------------------------------------------------------------------------ <br /> ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - _ <br /> -------- --- <br /> ' f' <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count I <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----ZZ�_z <br /> ---------------------------------((3ksfvAaerjjLnd c2r ontracfor <br /> --------------- <br /> C <br /> By:.-- ---------- <br /> ---------- <br /> ho ing a lot, location of system in relation to welIS1, bui1_d1in_gs_, etc., can be placed- on reverse side). <br /> (Plot plan, s' w size <br /> FOR DEPARTMENT USE ONLY <br /> .By-—------------- DATE-------------- <br /> APPLICATION ACCEPTES"i <br /> REVIEWED BY --------------- i <br /> %--F-------------------------------------------------------------------.-- DATE <br /> BUILDING PERMIT ISSUED---------------------- ------- ------ DATE -------------------------------- <br /> -- ------------------------ <br /> A terafions and/or recommendations:-__---------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- <br /> ..........I----------------------------- --------------------------------------------------------------------------------------_---------------I---------------I------------------------------------------------------------ <br /> --------------------------­------- -----------------I-------------------------------- ------------:------------------------------------ ------------------------------------------------------------------­------ <br /> ----------------------------------------- ---------------------- ---------- -------------------- ---------------- ------------------------ -------- ----- ---------------------------- ----------------------- <br /> FINAL INSPECTION ---------------------------- Date <br /> �:(-__/17- <br /> -------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />