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ii I <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> 44 Date Issued y ------ <br /> Applica+ion 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 Ordinance No. 549. <br /> JOB ADDRESS LOC -------- ------ ------- -- e4----------------------- -------- <br /> Y-� -W2 <br /> LOC�M2�w ------7))77" <br /> - -- - ---------- ---- -- ------ - <br /> ---------------------- ------ --- -.-- Phone-------------------- ------------- <br /> Owner's Name--- <br /> -------------- ----­----------I--------------------------------------------- ----------I------------ <br /> --:-------------- <br /> Address---------- JL------F------ ---------- ---------- <br /> Contractor's Name_____ ---------------------------------------------------------------------------------------------------- -------------- Phone_______________---- <br /> ce Apartment House El Commercial 0 Trailer Court [] Motel 0 Other <br /> is <br /> Installation will serve: Y- c. <br /> Number of living units: ___f____ Number of bedrooms -___1'Number of baths --_/___ Lot size -------- <br /> Water Supply: Public system [I Community system El Private Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel El Sandy Lo 0 ClayUbarn � Clay 0 Adobe E] Hardpan 0 <br /> Previous Application Made: Yes E] No New Construction: Yes, No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> it <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Distance from nearest we 001--Distance f(Yundatio M f 'a-1 <br /> .5- ll__ <br /> _ [ .__Distance <br /> rl ----------------------- ------- ------------- <br /> Septi Tank: <br /> k --------_Capaci, <br /> No. of compartments---------4701, Size---- Liquid depfh------ ___l---------- <br /> iel <br /> Dispos I Field: Distance from nearest well__. _ __6-10----Distance fr6m foundation___ <br /> Distance to nearest lot I' <br /> V1 Number of lines----------- ---- Length of each-line-----/_1)�_ Width of french-------2-9_14______________-al.. ;4�___Dcpth of filter material----- ______Total length--------J-210---1 --------- <br /> _6 Type of filter material.._ __T <br /> Seepage Pit: Distance to nearest:well----------------------Distance from foundation____---------------______________.Distance to nearest lot line-'..---.__._____ <br /> Number <br /> ine- -------------- <br /> Number of pits----------------------Lining material---------------------.- Size: Diameter-----------------------Depth------- ---------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.____-.___.,.._ Lining r�aterial-----------------------!l,--------------- <br /> ElSize: Diameter----- _ -------- ---------Depth-------- ------------------------------------------Liquid Capacity----------- �.-gpjs-­ <br /> -4 well_____---------------------------------- ---------Distance from nearest buildil <br /> —P riv-y--. Distance from real ----------------------7--------------- <br /> ElDistance to nearest lot line------ ------------------------------------------------------------------------------------------------------------------------------------- <br /> Remod-e--l-i-n--g----a--n--d--/--o--r----r-e-p--a--i-r-;-n--g----(-d--e--s--c--r-i-b--e--)-:-.-.-.-------------------------------------------------------------------------- - <br /> --------------------------------------------------------------------------------------------------- ----------------------------------------------------- <br /> — N- <br /> ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------7---Ell <br /> I hereby certify Wat-I have prepared this application and that the work will be done in accordance wifh.San Jil <br /> ws,4an rules and re)gulations of the-San Joaquin Local Health District. <br /> ordinances, State la <br /> tracto <br /> (Signed)----------- - --- --------------- ---------------------------------------------------------------------------------- -------{Owner and/or C;nitracfo <br /> r By:-------------------------------------------------------------- -------------- ---------------(Tif le)--------------------------------------------- ----------- <br /> -------------------------------------- <br /> (Plot plan,showing.sizl lot, location of systerl-relation to wells, buildings,-et C., can 6e_pIaced_on_rev.ersjsiqeI._� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------- ---- --- --------------------------------------------------------- DATE------------------------------ •-----"z" ''sem <br /> -- --------------------------------------------- DATE---------&`-___-_�'�_. ___--=---------_ <br /> REVIEWED <br /> ATE-------------------------------------- <br /> REVIEWEDBY-------------------------------•------------- J--- -- - ----- ----------- ------ -------------------------------------- DATE----------------- -- --------—----------------- <br /> BUILDINGPERMIT ISSUED------_-_---*-------------- -- --------------------------------------------- DATE---------&?-------------------------------------- <br /> - ------------ ------------! <br /> Alterations and/or recommendations:------- ------------------------------------------------------------------- --_--------•--------"e.------------- - <br /> ------------I-------- ------I-------------------------------------------I------------------------------------- ---------------------------------------------....._...-------...--------•=---------------------•h---------- <br /> 1 : ------------- <br /> ------------ - -------------------------------- -••----------- -----------------------------------------------------------------------------I.,-----------------------------------------------------7- <br /> -----------I------------------------------------- ---------I----------------- ------------------­­--------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------I--------------•-----------------------------°---•----------- ----------------------------------------------- --------------------- ------------------------ <br /> FINAL -INSPECTION 'BY________________ ----------- Date-':--------- ------ <br /> ---- -------- -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sfil 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M ; . Revised W-2100 <br />