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7— V <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <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 Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-----t i/-----------/1 1-0-----------F. --....---•- 0----------- --------- --------- <br /> ------------------- ------ <br /> Owner's Name------------- -------------------------- Y Phone__ . `7�/ <br /> - <br /> Address-------------------- ---------- ------- ------------­----­I--------------­---------------------------------­­­----------------------------------- <br /> Contractor's Name------------------------------ �_EL----- ------- .......... ---------------------------------------------- Phone--- -7------- <br /> -- - --------- <br /> Installation will serve: Residence-0 Apartment House [] Commercial J-] Trailer Court R Motel [] Other El <br /> Number of living units: j/----- Number of bedrooms --l—Number I of baths __f___ Lot*size ------- <br /> ---------------- <br /> Water <br /> ------Water Supply: Public system' Community system El Priv'ate 0 'Depth to Wafer Table ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy LoC7 E] Clay Loam E] Clay E] Adobe. Hardpan El <br /> Previous Application Made: Yes E] No 34— New Construction: Yesg—No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I I rt <br /> (No septic tank or cesspool permitted if public sewer is available Within 200 feet.) <br /> Septic Tank: Distance from nearest we149,XW4?----Distance fjorn foundafion-1-0-F-------Material----- <br /> jx_ No. of compartments-------2- - -6'1 q <br /> _____________ 7 <br /> ---------------Liquid depth___q9:2-�w-k"----Capacify--F _'__A <br /> 6 le ; <br /> Disposal Field: Distance from nearest wel&-1&XV,__Disfanc-e3 from�foDndafion---I-10---------DistanVce-,4f'o nearest lot line--_---_-�e_ <br /> _fizy Wmber of lines._________-_______________________Length of each,Iiinel_flr____t- _in---------Width of trench-__-�A__S/n------------------ <br /> Type of filter material-------------------------Depth of filter material___-____-_--_--- --__-Total length___-____-_-________-______________________ <br /> Seeps e <br /> ength------------------------------------------- <br /> See2e Pit: Distance fo nearest well---� __-_Distance fro f . clafion---el 11' tzince..to nearest lot line------A.1-1 <br /> Number of pits-_____j_____________Lining materi a -9-Size: Diameter__.. <br /> ia mefer__.. _3........Depth.-= __ --------------- <br /> -- <br /> Cesspool: Distance from nearest well____________-__Distance from foundation------------------- Lining >material________-____-______-________________- <br /> El Size: Marnefer--------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. -1 <br /> Privy: Distance from nearest well---------------------------------------------------Dista nce*f Fo—mnea rest bui4cling----------------------------------- ------- <br /> F1 Distance to nearest lot line------------------------------------------------::----— - <br /> - --- -- --------------- ---------------------------------- -------­­-- ---------- - <br /> Remodeling and/or repairing (describe):--------------------------------------------------------I----------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------I------ ----------------- -----------1------------------------------------------------- <br /> ------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - <br /> --------------------------------------411__�-----------------------------------------------------------------------------!--------------------------------------I------------------11---------------------------------------- <br /> I hereby certify at I ave prepared this application and +hat the work will be done in accordance with San Joaquin County i <br /> ordinances, State rules and regulations of the San Joaquin Local Health District. <br /> (Signed)..--............ -------- ---------------------ff�----------- ------- <br /> ------------------------------------------------------------------------------- townerwand/.or Contractor) <br /> By:--------------------------(__� <br /> t� (Title)--- -- ------- <br /> - - ------ -- ------ - - -- ------ ----- ------- ------- <br /> (Plot plan, showing size Cfi_otl), �Iocation of syfe---rin relation to be placed on reverse side). <br /> .7 1 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> BY ----------------------------------- DATE_�E------------------------------------------------------------------------------------------------ <br /> - <br /> REVIEWED BY--------------------------- T - DATE-_ � ------ <br /> BUILDING PERMIT ISSUED-------- I--------------------------- --------- DATE--------qf\--------------------------------------------- <br /> Alterations and/or recommendations---------------------------------- --- --------------------------------------------- -------------------------------------------------- <br /> ------------------------- <br /> -----------------------------------------------------------------------------I----------------------------------------------------------- --------------------------------------- -------------------------------------- <br /> ------------------------------------------------- ----------------------------------------------------I-------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------- ------------------------------------ ---------- ----------------------------------------------------------------------------I--------- ---------- ------ <br /> -------------------------------------------------------------------------------------------------------------------------- --------------------1-------- ------- --- ------------------------------------------------ <br /> FINAL INSPECTION BY...--------- ------------------------ Da'f,...... ------------------------------------------ <br /> - ------ -- ---- <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 10.52 Revised W-2100 <br />