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CP7 <br /> 'APPLICATION FOR SANITATION PERMIT Permit No.-----Z�q <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit tc4lci�nstrucf and install the work herein described. <br /> (11�1 Is application is made in compliance with County Ordinance No. 549. <br /> -------- -- - -- --------- - - --- --------------------- ----- ----------------------- ---- -------------- <br /> JOB ADDRESS AND LOC ION -------- ------- <br /> t <br /> Owner's Name--------- - ---------0- 1 11 I-M i I <br /> ZV- __ -.... . ... ------------- Phon ---- -------- ----- ---- <br /> Address- - - ----- -Z <br /> ------ ---- ------ <br /> -------------- <br /> Contractor's Name--- -- ------ <br /> __ -__--- ---- ----- <br /> ::--- Phone <br /> Installation will serve: Residence Apartment ouse [],-Cornmercial Trailer Court F] Motel Other ❑ <br /> Number of living units: Number of be-dror6ms -7.. Number of ath�s <br /> 11 _//--- Lot size <br /> Water Supply: Public system Community [:1 Private [:1 Depfh-to'-Wafer'Tabl,'4:�; ff. <br /> Character of soil to a depth ofA feet: Sand E] Gravel E] Sandy Loam E] lClay Loa El Clay F] Adobe Hardpan El <br /> Previous Applicafion.-Made. Yes E] No New. Construction: Yes No FHA'�VA. Yes Ej N <br /> e., 9 <br /> E] <br /> ,.TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer-is ayailable.within.200 feet.) <br /> plicT k Distance from nearest well________________Distance from foundation----- ----------Materlai-I------------ <br /> ,c <br /> No. of compartmenfs--------------------------Size------------------------------.-Liquid depth--------------------------Capacity----------------------- <br /> isposall F Distance from nearest well___________----.-Distance from foundation-____r_______'..___Qistance to nearest lot line_________________ <br /> �� Number <br /> ine----------------- <br /> Number of lines-----------------------------------Length of each line----------------I--------------Width of french <br /> Type of filter material------------------------Depth of filter material--------I---------� __Total length_____________-----______________------- <br /> Seepage if: Distance to nearest welIA-_--L-0-_____Distance from Winclatio _"Aistance to nearest ne ------ <br /> 'Number of pits.._.______________Lining material,-72r2K------Size: Di' oter___�U----- Depth_____---_----- ---------- <br /> I Distanc 6 from nearest well_________________Distance from foundation----i---------------Lining material--------- - <br /> -------------------- <br /> t—'j 0 /Size: Diameter------------------------- Depth------­� - 't <br /> I-----Liquid Capacity-. --------------------- 'gals. <br /> :------------ ---- <br /> Privy: Distance from nearest welf----- -------------------------------------------Distance froml.nearest building---------------------------- ------------ <br /> F1 Distance to nearest lot line------------ <br /> - --------------------------- - -------- <br /> Remodek ring�p a i (de_scrib;):'_ ----------- ---- --------------- - - - ------ <br /> fzQ <br /> ------------------------------------------------ ---- ------ ------------------------ ------ ---- -----------L <br /> /------ ----- ----------------------------- --- <br /> -------------------------------------------------------------------------------------------------------- ------------------------------ <br /> -- -------------------------------------------------- - --------------------------------------------------------------- ---- <br /> ----------------------------------------------------------------------------------------------------- ------------------------I--------------------------------------- <br /> I hereby certify that I have prepared this a p licaf i andt the work will be done in accordance with San Joaquin County <br /> ordinances, State ]a s nd rul a r gulati J <br /> Of t an quin Local Health District. <br /> (Signed) ---- -- ------- ----- ---- - -- ---- - - ----------------- <br /> --- <br /> (0 <br /> w er d <br /> /o---r---C---o--n---t--r-a--c--t-o--r-) <br /> By: ------------------------ <br /> ----------------------- - {Title <br /> (Plot plan, s owin iz floca ion of system in relation to wells, buildings, etc., can'6e paced on revers Ie- - <br /> FOR DEPARTMENT USE ONLY <br /> if 4 <br /> APPLICATION ACCEPTED BY------W1 ------------------------------------------------ DATE--------------------'13 <br /> -- ----------------------------- <br /> REVIEWED BY------------- ----------------------------------------------------------------------------------------------------------------I DATE <br /> BUILDING PERMIT ISSLIED"--------------------------------------------------------------------------------------------------- DATE <br /> -------------------------- <br /> Alterations and/or recommendations:___________________ <br /> --------------�__?----------------------------------------------------------------------------------------------- <br /> O -------- ------------------ ------- <br /> ------------------- <br /> ----------- ----------- <br /> ------------------------------------------------------------------- ------- <br /> ------------------------------------------------------------------------------------------------------------------------- ------------ <br /> ----------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------r------------------- ............... <br /> FINAL INSPECTION $Y:. -- <br /> -------------------- Date---- <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 Reviseci 1.57 F,P,CO. <br />